Comparison of the effects of inverted internal limiting membrane flap technique and internal limiting membrane peeling technique on macular hole after vitrectomy

Objective To compare the therapeutic effects of inverted internal limiting membrane flap technique and internal limiting membrane peeling technique on macular hole after vitrectomy. Methods Forty patients (40 eyes) with macular hole admitted to the First People’s Hospital of Zhumadian from March 2016 to March 2018 were selected, and they were divided into research group and control group according to random number table method, with 20 cases (20 eyes) in each group. All the patients received vitrectomy. In addition, research group was given inverted internal limiting membrane flap technique, while control group was treated by internal limiting membrane peeling technique. And they were given postoperative 6-month follow-up. The closure rate of postoperative macular hole, closure rate of ellipsoid area, closure types of macular hole, closure time of macular hole, closure time of ellipsoid area, time of best corrected visual acuity (BCVA) were compared between the two groups. BVCA (logMAR) was detected before operation and 5, 12 and 24 weeks after operation, and the complications of the two groups were recorded. Results The closure rate of macular hole and closure rate of ellipsoid area in research group were 100% (20/20) and 30% (6/20), higher than 70% (14/20) and 0% (0/20) in control group (P<0.05). The closure type of macular hole closure in research group was mainly U-shape (50%), and it was mainly V-type (45%) in control group, and the difference between the two groups was statistically significant (Z=-2.062, P=0.039). At 5, 12 and 24 weeks after operation, BVCA(logMAR) in the two groups showed the increased trend, compared with preoperative value, the increased speed of research group was higher than that of control group (P<0.05). The closure time of macular hole, closure time of ellipsoid area, time to normal BCVA in research group were (14.21±3.51) d, (12.14±2.69) d, (30.74±11.24) d, shorter than (21.12±4.67)d, (17.32±3.13)d, (46.79±12.41)d in control group (all P<0.05). After surgery for 1-7 d, 1 case of increased intraocular pressure was found in research group and 2 cases of increased intraocular pressure in control group. However, they returned to normal level after locally using intraocular pressure-lowering drugs. During 6-month follow-up, there were no severe complications in neither group. Conclusions Inverted limiting membrane flap technique in the treatment of macular hole after vitrectomy has better therapeutic effects than internal limiting membrane peeling technique. The closure rate of postoperative macular hole is higher, and most of them are U-shape. The inverted internal limiting membrane flap technique can achieve ideal postoperative closure of ellipsoid area, improve patients’ visual acuity with less complications, which is a safe and effective treatment method for macular hole. Key words: Retinal perforations; Vitrectomy; Inverted internal limiting membrane flap technique; Internal limiting membrane peeling technique