A novel video overlay guided enlargement of area of ILM peeled versus inverted flap technique: A long-term study in large macular holes

Abstract

Background/Aim: To compare the intra-operative video overlay guided enlargement of Area of ILM peeled (AIP) more than three Disc Diameter (DD) versus the inverted flap technique in large (>400 µm ) Full Thickness Macular Holes (FTMH). Methods: Retrospectively, 127 cases of large FTMHs divided into two groups (i) Group A ( n = 62)—intra-operative video-overlay guided enlargement of AIP > 3DD performed and (ii) Group B ( n = 65)—Inverted flap technique was done. Mean Best Corrected Visual Acuity (BCVA), hole closure rate and postoperative foveal anatomy were noted on Optical Coherence Tomography (OCT). Results: Mean Minimal Diameter of Macular Hole (MDMH) were 632.05 ± 146.62 µm (A) and 677.24 ± 152.08 µm (B). Hole closure rate were 93.55% (A) and 96.92% (B). Mean preoperative BCVA was 1.07 ± 0.37 Log MAR (A) and 0.94 ± 0.23 Log MAR (B). Mean postoperative BCVA at 3 months were 0.73 ± 0.22 Log MAR (A) and 0.83 ± 0.24 Log MAR (B). One-way ANOVA test showed statistically better visual improvement in Group A at 3 months ( p = 0.02), 6 months ( p = 0.045), 12 months ( p = 0.002), and 24 months ( p = 0.011). Chi square test revealed Type I pattern of hole closure was statistically more in Group B ( p < 0.001). Delayed Recovery of Outer Retinal Layers was more in group B (Pearson Chi square test, p = 0.039). Conclusion: Anatomically, macular hole closure rate as well as closure pattern was better in Group B. But functional improvement was better in Group A.