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    Inverted flap technique yields high success rates

    Chicago—The inverted internal limiting membrane (ILM) flap technique is not only a safe and effective procedure for treating macular holes, but compared with conventional ILM peeling, it is significantly more effective for achieving macular hole closure in certain situations, said Stanislao Rizzo, MD, at Retina Subspecialty Day 2016.

    “In our experience, the inverted ILM flap technique is more effective than conventional ILM peeling for treating large macular holes measuring >400 microns, myopic macular holes, macular holes with chorioretinal atrophy, and myopic macular holes with retinal detachment,” said Dr. Rizzo, chairman, Department of Ophthalmology, Careggi University Hospital, Florence Italy.

    The inverted ILM flap technique was first reported in the literature in 2010 in a paper by Michalewska et al. that presented the results of a randomized clinical trial [Ophthalmology. 2010;117:2018-2025]. The surgery begins with core vitrectomy and dye staining.

    However, instead of the ILM being completely removed, a remnant is left attached to the edges of the macular hole. The remnant is then inverted upside-down and used to cover the macular hole.

    Dr. Rizzo noted that since that original publication, two other variants of this innovative macular hole surgery technique have been described in the peer reviewed literature. One is a perfluoro-n-octane-assisted single-layered technique reported by Shin et al. [Retina. 2014;34:1905-1910].

    And most recently, a paper by Andrew et al. described autotransplantation of the ILM [Retina. 2016;36:834-837.]. In the latter approach, a piece of the ILM is taken out of the macula and inserted into the bottom of the macular hole.

    Tissue repair mechanism

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