Macular Hole Closure by Internal Limiting Membrane Flap without Gas Tamponade versus Conventional Surgery: A Comparative Study.

PURPOSE: To compare the effectiveness and safety of the novel internal limiting membrane (ILM) flap with no gas tamponade technique and conventional surgery in repairing macular hole (MH).

DESIGN

Retrospective comparative study.

PARTICIPANTS

Consecutive patients with OCT confirmed full-thickness MH who underwent MH repair surgery by either conventional surgery or the ILM flap with no gas tamponade technique at the Hong Kong Eye Hospital from November 1, 2021, to July 31, 2024.

METHODS

Medical records were reviewed for demographics, perioperative clinical features, operative details, and OCT features.

MAIN OUTCOMES MEASURES: The primary outcome was the rate of MH closure by postoperative month 3. Secondary outcomes included postoperative logarithm of the minimum angle of resolution visual acuity (VA) and OCT features, such as rate of foveal gliosis, dissociated optic nerve fiber layer (DONFL) score, integrity of external limiting membrane (ELM) and ellipsoid zone (EZ), and MH closure pattern.

RESULTS

Ninety-three eyes from 93 patients were included in the study, of which 51 eyes underwent MH repair with conventional surgery and 42 underwent the ILM flap with no gas tamponade technique. The MH closure rates were comparably high in both groups (94.1% vs. 95.2%; P = 0.812). Visual acuity was significantly better in the no gas tamponade group at postoperative week 1 (1.48 vs. 0.84; P < 0.001) and month 1 (0.87 vs. 0.73; P = 0.048). There were no significant differences in VA by postoperative months 3 (0.54 vs. 0.49; P = 0.281) and 6 (0.41 vs. 0.47; P = 0.991). In multivariate analysis, the rate of foveal gliosis was lower in the no gas tamponade group (20.0% vs. 4.9%; P = 0.043) whereas the MH closure pattern, DONFL score, and ELM/EZ integrity were similar between the 2 groups.

CONCLUSIONS

The ILM flap with no gas tamponade technique could achieve a high MH closure rate comparable to conventional surgery. This novel technique was associated with significantly better vision in the first month of the postoperative period, as well as a lower rate of foveal gliosis. These results demonstrated the feasibility of repairing MH without gas tamponade and warrant further prospective study.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.