Internal Limiting Membrane Free Flap Transposition with Tuck Technique for Previously Failed Vitrectomy in Chronic Full Thickness Macular Hole

Abstract

Purpose: To assess an alternate treatment for chronic FTMH where primary surgery has failed. Methods: A retrospective, interventional study conducted in a single center by a single surgeon in Hong Kong included consecutive patients with FTMH for at least 1 year and at least 1 previously failed vitrectomy with ILM peeling. A 25 Gauge vitrectomy with ILM free flap transposition was done without secondary assistance of PFCL, viscoelastic, or autologous blood. The free flap was manually tucked into the FTMH space and gas fluid exchange (20% SF6) was performed with prone posturing for 2 weeks postoperatively. Preoperative visual acuity (VA), macula hole duration, previous surgeries, Optical Coherence Tomography (OCT), appearance, and hole size were recorded. Postoperative 3 months VA, hole closure rate, and OCT appearance were also documented. Results: 6 consecutive patients qualified from May 2016 to Feb 2018. 66% right eye, 66% female, with an average age of 65 years old. Transposition surgery was performed an average of 953 days (228 to 2349) after diagnosis of macula hole. Macula hole average size was 0.838 mm (± 0.5), preoperative VA was logMAR 1.09 (± 0.15), postoperative VA was logMAR 0.76 (± 0.29) with 1.4 lines gained and a significant improvement of logMAR 0.33 (P = 0.0138). Hole closure was seen in 5 out of 6 eyes (83.3%). The OCT with failed closure showed ILM flap within a flat hole, however no overlying neurosensory layers seen. The duration from diagnosis to surgery was 2349 days in this case. Conclusions: Free flap ILM transposition tuck is an effective technique in treating chronic FTMH with previously failed surgeries.