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Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: conventional internal limiting membrane peeling versus inverted flap

  • 期刊论文

  • 发表日期：

    2024年8月24日

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  • Matteo Fallico,
  • Paolo Caselgrandi,
  • Paola Marolo,
  • Guglielmo Parisi,
  • Enrico Borrelli,
  • Federico Ricardi,
  • Francesco Gelormini,
  • Luca Ceroni,
  • Michele Reibaldi,
  • Tommaso Micelli Ferrari,
  • Massimo Lorusso,
  • Vito Primavera,
  • Gianluigi Giuliani,
  • Cesare Mariotti,
  • Marco Lupidi,
  • Luca Ventre,
  • Antonio Valastro,
  • Lorenzo Motta,
  • Mikes Nomikarios,
  • Francesco Boscia,
  • Giacomo Boscia,
  • Mario R. Romano,
  • Mariantonia Ferrara,
  • Miroslav Kacerik,
  • Daniele Marchina,
  • Barbara Parolini,
  • Enrico Peiretti,
  • Valentina Carta,
  • Roberto dell’Omo,
  • Marzia Affatato,
  • Teresio Avitabile,
  • Andrea Russo,
  • Antonio Longo,
  • Vincenzo Scorcia,
  • Adriano Carnevali,
  • Rodolfo Mastropasqua,
  • Matteo Gironi,
  • Agostino Salvatore Vaiano,
  • Riccardo Merli,
  • Marco Mura,
  • Marco Pellegrini,
  • Fabrizio Giansanti,
  • Cristina Nicolosi,
  • Matteo Badino,
  • Nicola Pallozzi Lavorante,
  • Maria T. Sandinha,
  • Francesco Maria D’Alterio,
  • Mario Damiano Toro,
  • Robert Rejdak,
  • Paolo Chelazzi,
  • Claudia Azzolini,
  • Francesco Viola,
  • Caterina Donà,
  • Matteo Giuseppe Cereda,
  • Salvatore Parrulli,
  • Marco Codenotti,
  • Lorenzo Iuliano,
  • Grazia Pertile,
  • Daniele Sindaco,
  • Stefano De Cillà,
  • Micol Ester Alkabes,
  • Vincenza Bonfiglio,
  • Maria Vadalà,
  • Alberto La Mantia,
  • Viviana Randazzo,
  • Tito Fiore,
  • Gianluigi Tosi,
  • Rino Frisina,
  • Chiara Angeli,
  • Marco Coassin,
  • Mariateresa Laborante,
  • Tommaso Rossi,
  • Luca Placentino,
  • Stanislao Rizzo,
  • Matteo Mario Carlà,
  • Magda Gharbiya,
  • Giuseppe Maria Albanese,
  • Luigi Caretti,
  • Martina Formisano,
  • Gian Marco Tosi,
  • Tommaso Bacci,
  • David H. Steel,
  • Nikolaos Dervenis,
  • Iordanis Vagiakis,
  • Daniele Tognetto,
  • Marco Rocco Pastore,
  • Francesco Faraldi,
  • Carlo Alessandro Lavia,
  • Paolo Lanzetta,
  • Leopoldo Rubinato,
  • Daniele Veritti,
  • Paolo Radice,
  • Andrea Govetto

摘要

Background

To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole.

Methods

Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes.

Results

A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04).

Conclusions

The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.