Ganglion cell layer changes following the idiopathic macular hole surgery using inverted limiting membrane flap technique

Abstract

Purpose: The purpose of this study is to compare the ganglion cell layer changes following temporal inverted internal limiting membrane flap (i-ILMF) surgery for idiopathic macular hole (IMH).

Methods: This retrospective study included 50 eyes that underwent vitrectomy with a 2.5-disc-diameter temporal inverted internal limiting membrane flap (i-ILMF) technique. Demographic, functional, and anatomical data were collected before and after the surgery. The best corrected visual acuity (BCVA) and optical coherence tomography (OCT) findings such as ganglion cell layer -inner plexiform layer (GCL-IPL) thickness and hole related parameters/indexes were compared in the preoperative period and 6th month after surgery.

Results: The average age of the patients was 68.8 ± 10.31 years, and the average duration of visual loss was 10.95 ± 6.54 months. The average GCL-IPL thickness increased significantly from 57.98 ± 21.43 μm to 68.74 ± 13.62 μm at 6 months after surgery (p < 0.001). The nasal GCL-IPL thickness was significantly increased from 56.94 ± 24.18 μm to 73.10 ± 15.39 μm after 6 months after surgery (p < 0.001).

Conclusion: The temporal i-ILMF technique not only leads to high anatomical success and visual improvement but also results in a significant increase in GCL-IPL thickness postoperatively, suggesting a unique structural response to this method.

Keywords: Ganglion cell layer; Idiopathic macular hole; Temporal inverted internal limiting membrane flap technique.

Fig. 1

These boxplots demonstrate pre-operative and post-operative BCVA in LogMAR

Fig. 2

Pre-operative and post-operative changes are demonstrated in Macular Cube OCT images

Fig. 3

Pre-operative and post-operative changes are demonstrated in ganglion cell analysis. After temporal i-ILMF technique, particularly average and nasal quadrant GCL+IPL thickness increased

Fig. 4

This boxplots demonstrate pre-operative and post-operative GCL-IPL thickness in temporal, nasal and average

Fig. 5

This figure shows inverted ILM flap technique and ILM folding at hinge region

Fig. 6

Intraoperative screenshots demonstrating the steps of temporal inverted internal limiting membrane (ILM) flap preparation. A After ILM staining, initiation of ILM peeling from the temporal side. B, C Creation of a temporal ILM flap approximately 2.5 disc diameters in length. D The prepared flap is folded to cover the macular hole and the nasal papillomacular bundle. E,F Visualization of the non-contact ILM flap covering the macula under fluid. G, H Appearance of the ILM flap covering the macular hole under air, and drying of the macula by aspirating residual fluid with a soft-tip cannula over the optic disc