COMPARATIVE STUDY OF MACULAR HOLE (MH) SURGERY: INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VS. AMNIOTIC MEMBRANE GRAFT
Main Article Content
Keywords
ILM flap, Amniotic Graft, Macular holes, Retinal Detachment.
Abstract
Background: Macular holes remain difficult to treat, despite advancements.
Conclusion: This comparative study demonstrates a significant difference between anatomical success and patient-reported outcomes in MH surgery. The unanticipated inverse association between satisfaction and perceived quality of life (QoL) improvement indicated that psychological variables and disappointed expectations may have a significant impact on postoperative experiences in addition to quantitative visual outcomes.
Methodology: This study has a prospective cohort, comparative study design. The study lasted for 6 months. The study was conducted in the Mayo Hospital, Lahore. 20 patients were included in the study who had macular hole surgery, 10 in each group (ILM Flap and AMG). IBM SPSS 27 v. was used to analyse the data. An independent sample t-test was used to compare the means of two independent groups (ILM flap and AMG) on a continuous dependent variable (BCVA postoperative).
Results: The mean age (Mean=65.85 years) with SD=5.95. Females formed a larger proportion of the sample (65%) than males (35%). The internal limiting membrane flap group had a significantly higher mean ETDRS score (Mean=64.84, SD=5.18) than the AMG (Mean=49.78, SD=3.05), p<0.001. 69.2% of study participants with poor satisfaction reported improved quality of life (QoL), compared to 28.6% in the high satisfaction group, with p =0.073.
Conclusion: This comparative study demonstrates a significant difference between anatomical success and patient-reported outcomes in MH surgery. The unanticipated inverse association between satisfaction and perceived quality of life (QoL) improvement indicated that psychological variables and disappointed expectations may have a significant impact on postoperative experiences in addition to quantitative visual outcomes.
References
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14. Li D, Ye Q, Li C. Auto-transplantation of the anterior lens capsule and blood for a recurrent large macular hole. Int J Ophthalmol [Internet]. 2020 Nov 18 [cited 2025 Jul 10];13(11):1839–40. Available from: https://pubmed.ncbi.nlm.nih.gov/33215020/
15. Qiao G, Xie L, Zou Q, He C, Zhang X, Tang Z, et al. The use of biological amniotic membranes in the treatment of recurrent macular holes. Sci Rep [Internet]. 2022 Dec 1 [cited 2025 Jul 10];12(1):1–6. Available from: https://www.nature.com/articles/s41598-022-21754-8
16. Zhu D, Jin X, Zhou J. Transplantation of amniotic membrane for choroidal hole to treat suprachoroidal silicone oil migration. Acta Ophthalmol [Internet]. 2017 Sep 1 [cited 2025 Jul 10];95(6):e522–3. Available from: https://pubmed.ncbi.nlm.nih.gov/28696567/
17. Caporossi T, Pacini B, Bacherini D, Barca F, Faraldi F, Rizzo S. Human amniotic membrane plug to promote failed macular hole closure. Sci Rep [Internet]. 2020 Dec 1 [cited 2025 Jul 10];10(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33106542/
18. Shen Y, Lin X, Zhang L, Wu M. Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis. [cited 2025 Jul 10]; Available from: https://doi.org/10. 1186/s12886-019-1271-2
19. Baumann C, Kaye S, Iannetta D, Sultan Z, Dwivedi R, Pearce I. Effect of inverted internal limiting membrane flap on closure rate, postoperative visual acuity, and restoration of outer retinal layers in primary idiopathic macular hole surgery. Retina [Internet]. 2020 Oct 1 [cited 2025 Jul 10];40(10):1955–63. Available from: https://journals.lww.com/ retinajournal/ fulltext/2020/10000/effect_of_inverted_internal_limiting_membrane_flap.12.aspx
20. Spiteri Cornish K, Lois N, Scott N, Burr J, Cook J, Boachie C, et al. Vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling for idiopathic full-thickness macular hole (FTMH). Cochrane Database Syst Rev [Internet]. 2013 Jun 5 [cited 2025 Jul 10];2013(6). Available from: https://pubmed.ncbi.nlm.nih.gov/23740611/
21. Sultan H, Wykoff CC, Shah AR. Five-year outcomes of surgically treated symptomatic epiretinal membranes with and without internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging Retin [Internet]. 2018 May 1 [cited 2025 Jul 10];49(5):296–302. Available from: https://pubmed.ncbi.nlm.nih.gov/29772039/
2. Majumdar S, Tripathy K. Macular Hole. StatPearls [Internet]. 2023 Aug 25 [cited 2025 Jul 7]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK559200/
3. Gupta OP. American Academy of Ophthalmology. 2025 [cited 2025 Jul 7]. Macular Hole - EyeWiki. Available from: https://eyewiki.org/Macular_Hole
4. Ferreira MA, Maia A, Machado AJ, Ferreira REA, Hagemann LF, Júnior PHER, et al. Human amniotic membrane for the treatment of large and refractory macular holes: a retrospective, multicentric, interventional study. Int J Retin Vitr [Internet]. 2021 Dec 1 [cited 2025 Jul 8];7(1):38. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8105940/
5. Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology [Internet]. 2010 Oct [cited 2025 Jul 10];117(10):2018–25. Available from: https://pubmed.ncbi.nlm.nih.gov/20541263/
6. Sborgia G, Niro A, Sborgia A, Albano V, Tritto T, Sborgia L, et al. Inverted internal limiting membrane-flap technique for large macular hole: A microperimetric study. Int J Retin Vitr [Internet]. 2019 Oct 1 [cited 2025 Jul 8];5(1):1–10. Available from: https://journalretinavitreous.biomedcentral.com/articles/10.1186/s40942-019-0195-6
7. Rizzo S, Caporossi T, Tartaro R, Finocchio L, Franco F, Barca F, et al. A Human Amniotic Membrane Plug to Promote Retinal Breaks Repair and Recurrent Macular Hole Closure. Retina [Internet]. 2019 Oct 1 [cited 2025 Jul 8];39:S95–103. Available from: https://pubmed.ncbi.nlm.nih.gov/30312261/
8. Meller D, Pires RTF, Tseng SCG. Ex vivo preservation and expansion of human limbal epithelial stem cells on amniotic membrane cultures. Br J Ophthalmol [Internet]. 2002 [cited 2025 Jul 8];86(4):463–71. Available from: https://pubmed.ncbi.nlm.nih.gov/11914219/
9. Shiode Y, Morizane Y, Matoba R, Hirano M, Doi S, Toshima S, et al. The role of inverted internal limiting membrane flap in macular hole closure. Investig Ophthalmol Vis Sci [Internet]. 2017 Sep 1 [cited 2025 Jul 8];58(11):4847–55. Available from: https://pubmed.ncbi.nlm.nih.gov/28973331/
10. Kalur A, Muste J, Singh RP. A Review of Surgical Techniques for the Treatment of Large Idiopathic Macular Holes. Ophthalmic Surg Lasers Imaging Retin [Internet]. 2022 Jan 1 [cited 2025 Jul 8];53(1):52–61. Available from: https://pubmed.ncbi.nlm.nih.gov/34982003/
11. Gu C, Qiu Q. Inverted internal limiting membrane flap technique for large macular holes: a systematic review and single-arm meta-analysis. Graefe’s Arch Clin Exp Ophthalmol [Internet]. 2018 Jun 1 [cited 2025 Jul 8];256(6):1041–9. Available from: https://link.springer.com/article/10.1007/s00417-018-3956-2
12. Tseng SCG, Espana EM, Kawakita T, Di Pascuale MA, Li W, He H, et al. How does amniotic membrane work? Ocul Surf [Internet]. 2004 [cited 2025 Jul 8];2(3):177–87. Available from: https://pubmed.ncbi.nlm.nih.gov/17216089/
13. Rossi T, Trillo C, Ripandelli G. Autologous internal limiting membrane transplant for recurrent idiopathic macular holes. Eur J Ophthalmol [Internet]. 2021 Mar 1 [cited 2025 Jul 8];31(2):656–63. Available from: /doi/pdf/10.1177/1120672120906391?download=true
14. Li D, Ye Q, Li C. Auto-transplantation of the anterior lens capsule and blood for a recurrent large macular hole. Int J Ophthalmol [Internet]. 2020 Nov 18 [cited 2025 Jul 10];13(11):1839–40. Available from: https://pubmed.ncbi.nlm.nih.gov/33215020/
15. Qiao G, Xie L, Zou Q, He C, Zhang X, Tang Z, et al. The use of biological amniotic membranes in the treatment of recurrent macular holes. Sci Rep [Internet]. 2022 Dec 1 [cited 2025 Jul 10];12(1):1–6. Available from: https://www.nature.com/articles/s41598-022-21754-8
16. Zhu D, Jin X, Zhou J. Transplantation of amniotic membrane for choroidal hole to treat suprachoroidal silicone oil migration. Acta Ophthalmol [Internet]. 2017 Sep 1 [cited 2025 Jul 10];95(6):e522–3. Available from: https://pubmed.ncbi.nlm.nih.gov/28696567/
17. Caporossi T, Pacini B, Bacherini D, Barca F, Faraldi F, Rizzo S. Human amniotic membrane plug to promote failed macular hole closure. Sci Rep [Internet]. 2020 Dec 1 [cited 2025 Jul 10];10(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33106542/
18. Shen Y, Lin X, Zhang L, Wu M. Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis. [cited 2025 Jul 10]; Available from: https://doi.org/10. 1186/s12886-019-1271-2
19. Baumann C, Kaye S, Iannetta D, Sultan Z, Dwivedi R, Pearce I. Effect of inverted internal limiting membrane flap on closure rate, postoperative visual acuity, and restoration of outer retinal layers in primary idiopathic macular hole surgery. Retina [Internet]. 2020 Oct 1 [cited 2025 Jul 10];40(10):1955–63. Available from: https://journals.lww.com/ retinajournal/ fulltext/2020/10000/effect_of_inverted_internal_limiting_membrane_flap.12.aspx
20. Spiteri Cornish K, Lois N, Scott N, Burr J, Cook J, Boachie C, et al. Vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling for idiopathic full-thickness macular hole (FTMH). Cochrane Database Syst Rev [Internet]. 2013 Jun 5 [cited 2025 Jul 10];2013(6). Available from: https://pubmed.ncbi.nlm.nih.gov/23740611/
21. Sultan H, Wykoff CC, Shah AR. Five-year outcomes of surgically treated symptomatic epiretinal membranes with and without internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging Retin [Internet]. 2018 May 1 [cited 2025 Jul 10];49(5):296–302. Available from: https://pubmed.ncbi.nlm.nih.gov/29772039/
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Published
Sep 03, 2025
Article Details
How to Cite
Nida Khalid, Anusheh Khalid Waheed, Mustafa Khalid Waheed, Nouman Aleem, Amna Rizwan, & Muhammad Ayub Khan. (2025). COMPARATIVE STUDY OF MACULAR HOLE (MH) SURGERY: INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VS. AMNIOTIC MEMBRANE GRAFT. Journal of Population Therapeutics and Clinical Pharmacology, 32(8), 43-48. https://doi.org/10.53555/05r5mp60
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Author Biographies
Nida Khalid
Department of Ophthalmology, Mayo Hospital, Lahore, Pakistan
Anusheh Khalid Waheed
Department of Ophthalmology, Services Hospital, Lahore, Pakistan
Mustafa Khalid Waheed
Department of Ophthalmology, Lahore Medical and Dental College, Lahore, Pakistan
Nouman Aleem
Department of Ophthalmology, Mayo Hospital, Lahore, Pakistan
Amna Rizwan
Department of Ophthalmology, Avicenna Medical College, Lahore, Pakistan
Muhammad Ayub Khan
Department of Ophthalmology, Gomal Medical College, Dera Ismail Khan, Pakistan
How to Cite
Nida Khalid, Anusheh Khalid Waheed, Mustafa Khalid Waheed, Nouman Aleem, Amna Rizwan, & Muhammad Ayub Khan. (2025). COMPARATIVE STUDY OF MACULAR HOLE (MH) SURGERY: INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VS. AMNIOTIC MEMBRANE GRAFT. Journal of Population Therapeutics and Clinical Pharmacology, 32(8), 43-48. https://doi.org/10.53555/05r5mp60