OSLI Retina

July 2020

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376 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Practical Retina dition to providing a scaffold, the ILM tissue may contain Müller cell fragments, which has been pos- tulated to induce gliosis, and in turn may enhance MH closure. 9,14,15 The inverted ILM flap technique for large MHs, which was first described by Michalewska et al., uti- lizes a wide ILM with care to detach the peripheral macular ILM while keeping the ILM attached around the MH. 14 The detached ILM is then inverted and placed into the MH, followed by fluid-air-exchange. 14 This approach yielded a higher rate of closure in patients (98%) compared to traditional MH surgery (88%), along with improved visual outcomes. 14 A multicenter series by Narayanan et al. comparing the Figure 1. Broader internal limiting membrane (ILM) peeling for a refractory macular hole (MH). A 76-year-old man with recent MH and best-corrected visual acuity (BCVA) of 20/200 (A) underwent vit- rectomy, ILM peeling, and gas tamponade with in- complete closure of his MH after 1 month (B) and mild improvement of BCVA to 20/100. A subsequent broader ILM peel was performed and repeat gas tamponade with resulting closure of the MH (C) 1 month after surgery and improvement in BCVA to 20/30.

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