Predictive factors of surgical success with the Inverted ILM Flap Technique

Abstract

ABSTRACT Purpose: To present new morphological features correlating with functional and anatomical outcomes of the Inverted internal limiting membrane Flap Technique (iILMFT) in full-thickness macular hole (FTMH). Methods: A retrospective study of 51 successful and 22 failed FTMH surgeries. In all eyes, preoperative SD-OCT or SS-OCTs were reviewed. The presence of supra-RPE (retinal pigment epithelium) granular deposits, presence of an epiretinal membrane (ERM) or epiretinal proliferation (EP), visibility of posterior hyaloid, continuity of the interdigitation zone or external limiting membrane, presence of cystoid spaces, irregular surface of the margins of FTMH, visibility of the suprachoroidal space, diameters of FTMH were analyzed. Results: In multivariate analysis, the success of the first surgery depended solely on the absence of ERM (p<0.05). In univariate analysis, the success of the first surgery was correlated moreover with the absence of preoperative supra-RPE granular deposits (p=0.0010), the absence of an EP (p=0.0060), and the absence of an irregular border of the hole (p=0.010). Conclusions: In multivariate analysis, ERMs were a negative prognostic factor for macular hole closure when the iILMFT was used. Worse final visual acuity was observed in patients with primary anatomical failure, even if the hole was successfully closed during the second intervention.