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Pedicle transposition flap, inverted flap, free flap, and standard peel for large full thickness macular holes: a comparative study

Lookup NU author(s): Tafadzwa Young-Zvandasara, Roxane Hillier

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Abstract

Copyright © by Ophthalmic Communications Society, Inc. Purpose: To compare anatomical and functional outcomes of four different techniques for the treatment of large idiopathic full-thickness macular holes (FTMH). Methods: Single-centre retrospective study including 129 eyes of 126 patients with large (>500μm) FTMH between January 2018-October 2022. All patients underwent 23/25G vitrectomy and gas with standard internal limiting membrane (ILM) peel, pedicle transposition, inverted, or free flap technique. Postoperative OCT images were assessed by 2 independent masked graders. Results: Mean age was 73.2 years (SD 8.4) with median F/U of 5 months (IQR 8). Overall anatomical success rate was 81%; significantly lower (59%) for the standard ILM peel (p<0.0001). The pedicle transposition flap showed superior visual recovery compared to the free flap (+27 vs +12 ETDRS letters, p=0.02). At 3 months, restoration of the ELM was significantly better for the pedicle transposition flap compared to free flap and standard ILM peel (p=0.008 and p=0.03), and superior to all the other techniques at 6 months (p=0.02, p=0.04 and p=0.006). Conclusions: Standard ILM peel alone offers inferior outcomes for the management of large FTMH. Of the alternative ILM techniques, despite similar closure rates, foveal microstructural recovery is most complete following the pedicle transposition flap, and least complete following the free flap.

Publication metadata

Author(s): Macchi I, Huelin FJ, Young-Zvandasara T, Di Simplicio S, Kadhim MR, Chawla H, Hillier RJ

Publication type: Article

Publication status: Published

Journal: Retina

Year: 2024

Pages: ePub ahead of print

Online publication date: 02/05/2024

Acceptance date: 02/04/2018

ISSN (print): 0275-004X

ISSN (electronic): 1539-2864

Publisher: Lippincott Williams and Wilkins

URL: https://doi.org/10.1097/IAE.0000000000004142

DOI: 10.1097/IAE.0000000000004142

PubMed id: 39073100

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