The inverted internal limiting membrane (ILM) flap technique can be successfully used for the repair of a wide spectrum of macular holes, said Jerzy Nawrocki, MD, PhD.
The technique, developed by Dr. Nawrocki and his colleague Zofia Michalewska, MD, PhD, involves covering the macular hole with an inverted remnant of ILM that is left attached to the margins of the macular hole after ILM peeling.
The inverted ILM technique was first used for large macular holes (> 400 µm), and results of a prospective, randomized clinical trial [Ophthalmology. 2010;117(10):2018-2025] showed that compared with standard surgical repair, the inverted ILM flap technique achieved its goal of preventing the postoperative flat-open appearance of large macular holes and was associated with better visual acuity.
Subsequently, Drs. Nawrocki and Michalewska have applied the technique and a modification–the temporal inverted ILM flap technique–with success in a range of macular holes.
“The inverted ILM flap technique achieves regeneration of the structure of the fovea and photoreceptor layer in the fovea, and that correlates with improvement in visual acuity,” said Dr. Nawrocki, Ophthalmic Clinic Jasne Blonia, Lodz, Poland.
“When we first reported on our use of the inverted ILM flap technique, we already suggested it might be used in all cases of macular holes,” Dr. Nawrocki. “Our experience and reports from other surgeons confirm its efficacy. I encourage retina specialists who have not used this technique to give it a try.”