PROGNOSTIC FACTORS FOR DEVELOPMENT OF GLIOSIS AFTER INTERNAL LIMITED MEMBRANE FLAP FOR IDIOPATHIC MACULAR HOLES.

PURPOSE: To investigate the prognostic factors for development of gliosis after idiopathic macular hole (IMH) surgery and its relationship to functional and anatomical success.

METHODS

This retrospective study included patients with IMH that underwent pars plana vitrectomy using internal limiting membrane flap technique. Optical coherence tomography examinations were done at baseline, 1 month, and 6 months postoperatively. Postoperative parameters on optical coherence tomography included hole closure, outer retinal layers continuity, and development of gliosis.

RESULTS

Sixty-five patients with IMH were included in the study. Forty-three underwent temporal flap and 22 an inverted flap 360° around the hole. Gliosis was present at 8 (12.3%) eyes at 1 and 6 months postoperatively. Patients with gliosis at 6 months had larger minimal hole diameter at presentation (622 µ m ± 140 vs. 423 ± 178, P = 0.004). Gliosis was associated with worse best-corrected visual acuity at presentation (0.86± 0.49 logMAR [20/145] vs. 0.43 ± 0.37 [20/54], P = 0.008) and 1 month postoperatively (0.91 ± 0.59 logMAR [20/160] vs. 0.42 ± 0.48 [20/53], P = 0.013) but not at 6 months postoperatively (0.55 ± 0.31 logMAR [20/70] vs. 0.43 ± 0.33 [20/54], P = 0.222).

CONCLUSION

Our study supports the use of inverted internal limiting membrane flap for IMH as a primary procedure. No gliosis was shown in small macular holes undergoing this technique. Even in large IMH where gliosis has developed, an improvement in visual acuity was shown after surgery.