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Foveal microstructure and visual outcomes of myopic macular hole surgery with or without the inverted internal limiting membrane flap technique
  1. Xu-Ting Hu,
  2. Qin-Tuo Pan,
  3. Jing-Wei Zheng,
  4. Zong-Duan Zhang
  1. Department of Ophthalmology, Eye Hospital of Wenzhou Medical University, Wenzhou, China
  1. Correspondence to Dr Zong-Duan Zhang, Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China; zzduan{at}


Purpose The aim of this study was to determine the effect of the inverted internal limiting membrane (ILM) flap technique on the macular hole (MH) closure and foveal microstructure recovery of patients with highly myopic MH.

Methods Pars plana vitrectomy and gas tamponade with the inverted ILM flap technique (19 eyes) or with the ILM peeling technique (21 eyes) were performed in patients with highly myopic MH with or without retinal detachment. The rate of MH closure and retinal reattachment, the reconstructive anatomical change of the foveal microstructure and the best-corrected visual acuities (BCVA) of the two groups were compared.

Results The anatomic closure rate was statistically significantly higher in the inverted group (100%) than in the peeling group (66.7%; p=0.009). All eyes with MH retinal detachment had successful retinal reattachment in these two groups. However, the rate of the external limiting membrane (ELM) and ellipsoid zone (EZ) (p=0.020), as well as gliosis (p=0.049) in macular area, detected by OCT, was significantly greater in the inverted group than in the peeling group. The postoperative BCVA was significantly better in the eyes with ELM, EZ (p=0.031) and gliosis (p=0.008), but without hyperreflective foci (p=0.001).

Conclusions These findings demonstrate that the inverted ILM flap technique has better efficacy than the ILM peeling technique for patients with myopic MH in closure rate, foveal microstructure and postoperative BCVA.

  • inverted internal limiting membrane flap technique
  • myopic macular hole
  • macular hole retinal detachment
  • optical coherence tomography

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  • Contributors X-TH, Q-TP and Z-DZ conceived and designed the study. X-TH and Q-TP contributed to the acquisition of data and drafting the manuscript. X-TH and J-WZ were responsible for the analysis and interpretation of data. Z-DZ revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

  • Funding This study was supported by research grants from the Foundation of Medical Scientific Research Foundation of Zhejiang Province, China (no. 2015KYA163).

  • Disclaimer The author(s) have no proprietary interest in any materials discussed in this article.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board of the Eye Hospital of Wenzhou Medical University (Wenzhou, China).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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