Treatment of inverted internal limiting membrane flap technique combined with phacoemulsification for idiopathic macular hole with cataract

Objective To analyze the efficacy and safety of inverted internal limiting membrane flap technique combined with phacoemulsification and intraocular lens implantation for idiopathic macular hole (IMH) with cataract. Methods From January 2018 to July 2018, fifty-seven patients (57 eyes) with IMH treated with 23G vitrectomy in Renmin Hospital of Wuhan University, were included. The patients were divided into 2 groups. 41 eyes underwent inverted internal limiting membrane flap technique (A group), and 16 eyes underwent inverted internal limiting membrane flap technique combined with phacoemulsification and intraocular lens implantation (B group). The visual acuity recovery, macular hole changes and the incidence of complications were analyzed retrospectively. Results The best corrected visual acuity of the two groups was significantly improved after 6 months (P < 0.01), and there was no significant difference between group A and group B (P= 0.43). The closure rate of macular hole was 100.0% in both groups. There were 11 eyes (26.8%, 11/41) of group A and 5 eyes (5/16) of group B with temporarily increased intraocular pressure (P= 0.75), and 4 eyes (9.8%, 4/41) of group A and 6 eyes (6/16) of group B with temporary corneal edema (P < 0.01). Complicated cataract was found in 7 eyes of group A (17.1%, 7/41). Concurrently, posterior capsular opacity occurred in 1 case (1/16) of group B. No iatrogenic retinal breaks, macular edema, choroidal neovascularization or infective endophthalmitis occurred in both groups. Conclusions Inverted internal limiting membrane flap technique combined with phacoemulsification and intraocular lens implantation for IMH with cataract can achieve higher anatomical reduction rate and hole healing rate, and significantly improve the visual acuity of patients while avoiding secondary surgery. It is a safe and effective surgical operation. Key words: Idiopathic macular hole; Vitrectomy; Internal limiting membrane; Phacoemulsification