Anatomical Changes in the Fovea After Superior ILM Flap Placement for Treatment of Large Macular Hole
10.21561/jor.2025.10.1.31
- Author:
Bo Hyun PARK
1
;
Sung Who PARK
;
Iksoo BYON
Author Information
1. Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
- Publication Type:ORIGINAL ARTICLE
- From:
Journal of Retina
2025;10(1):31-37
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:To evaluate the anatomical changes in the fovea and macula after superior internal limiting membrane (sILM) flap surgery for treatment of large macular hole (MH).
Methods:Patients with large MH (minimum diameter > 400 μm) who were followed for at least 6 months after vitrectomy and sILM flap surgery were retrospectively reviewed. The best-corrected visual acuity (BCVA) and anatomical changes in the fovea (macular hole closure rate, foveal contour, recovery of the ellipsoid zone [EZ] and external limiting membrane [ELM], presence of foveal hyper-gliosis, and changes in retinal thickness of the superior and inferior quadrants around the fovea) were investigated. Retinal thickness was evaluated using the superior and inferior quadrants of the inner and outer rings of the Early Treatment Diabetic Retinopathy Study ring.
Results:Here, 20 eyes of 18 patients (14 idiopathic MHs, 1 traumatic MH, 2 age-related macular degeneration-related MHs, and 3 high myopia) were included in this study. The preoperative BCVA (logMAR) was 0.90 ± 0.39, and the minimum macular hole diameter was 608.3 ± 131.9 μm. Postoperatively, type 1 closure was achieved in all 20 eyes. Complete recovery of the EZ and ELM was observed in 6 (30.0%) and 13 eyes (65.0%), respectively. The retinal thickness of the superior and inferior quadrants of the fovea showed no significant difference in both the inner ring (289.5 ± 27.4 μm vs. 300.9 ± 24.2 μm) and the outer ring (260.3 ± 22.9 μm vs. 255.9 ± 21.1 μm).
Conclusions:The superior ILM flap technique involves creating an ILM flap from the superior area of the macula and then positioning it over the inferior area to cover the hole and provided a high success rate of hole closure. There was no anatomical difference in the upper and lower regions of fovea due to the residual internal limiting membrane.
