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Previous studies show that internal limiting membrane (ILM) peeling during macular hole surgery is associated with retinal shrinkage (microtubule depolymerization of the axons of the inner retina) and nasal shift of the fovea. A temporal inverted ILM flap technique was created to leave the nasal ILM intact and counteract this phenomenon. This study is a retrospective single centre study comparing complete 360 degree ILM peel (n=25) to the temporal inverted ILM flap (n=32). The mean postoperative papillofoveal distance on OCT was significantly shorter compared to baseline. These changes continued until six months in the conventional ILM group, but no significant changes occurred in the temporal ILM flap group after first month. Furthermore, postoperative complaints of metamorphopsia were significantly higher in the conventional ILM peeling group compared to the temporal ILM flap group. Metamorphopsia was associated with a higher papillofoveal length at month 12. Hence, foveal displacement seems to be one of the major contributing factors for postoperative metamorphopsia.

Foveal displacement following temporal inverted internal limiting membrane technique for full thickness macular holes: 12 months results.
Yilmaz S, Yildiz AM, Avci R.
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Kurt Spiteri Cornish

Sheffield Teaching Hospitals NHS Trust, London, UK.

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