Microstructural retinal regeneration after internal limiting membrane flap surgery for repair of large macular holes: a 1-year follow-up study

Int Ophthalmol. 2019 Jun;39(6):1277-1282. doi: 10.1007/s10792-018-0941-z. Epub 2018 May 9.


Purpose: To evaluate long-term change in functional and structural outcomes after successful repair of large macular holes (MH) with internal limiting membrane (ILM) flap techniques.

Methods: Eleven consecutive patients were reviewed over a 1-year time period after the successful repair of large MH with ILM flap techniques. SD-optical coherence tomography (SD-OCT) images were taken to assess the anatomical outcome after surgery, while the best-corrected visual acuity (BCVA) was tested using Snellen charts to evaluate the functional outcome. Each patient was evaluated at 1, 6 and 12 months after surgery, respectively.

Results: All cases achieved complete anatomical closure. All patients showed a microstructural regeneration of the retina with a decrease in ellipsoid zone defects over the 1-year follow-up. Functionally, as compared to baseline, all of the patients showed improvements in best-corrected visual acuity of 1-4 lines at the final examination after 12 months post-operatively.

Conclusions: Long-term results show further improvement in the best-corrected visual acuity as well as further microstructural regeneration of the retina and decrease in ellipsoid zone defects over time. The exact mechanism, which promotes closure of the macular hole and reconstruction of the ellipsoid zone after internal Limiting Membrane autograft surgery, still remains unknown.

Keywords: Ellipsoid zone; Free flap; Internal limiting membrane flap; Inverted flap; Macular hole.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Basement Membrane / transplantation*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Retina / pathology
  • Retinal Perforations / pathology
  • Retinal Perforations / physiopathology
  • Retinal Perforations / surgery*
  • Surgical Flaps
  • Visual Acuity / physiology
  • Vitrectomy / methods*