Okonkwo Ogugua Ndubuisi
Eye Foundation Centre For The Prevention Of Blindness, Nigeria
ScientificTracks Abstracts: Insights in Ophthalmology
Large and myopic macular holes have previously been shown to have poor anatomical outcome following conventional macular hole surgery, but can now be effectively closed with a high degree of predictability using the inverted internal limiting membrane (ILM) flap technique. This is usually followed by an improvement in function, which is seen on visual acuity testing and multifocal electroretinogram (ERG) as well. The immediate closure of the macular hole by this inverted ILM flap technique has been reported to be followed by a continued improvement in the macular microstructure, upto and over 12 months after surgery. The aim was to determine the number of eyes with continued improvement and the extent of foveal and parafoveal remodeling, by comparing immediate post-operative spectral domain optical coherence tomography (SD–OCT) images with scans taken after 10 months or more of follow up in 10 eyes that had inverted ILM flap technique for large size macular holes and also had a minimum post-operative follow up of 10 months. We investigated this by retrospectively reviewing the case records of patients and considered the degree of remodeling or change observed using the spectral domain optical coherence tomography (SD OCT) in the outer retina and then the inner retina. Specific attention was given to the foveal and parafoveal microstructure, including the foveal contour. Four out of the 10 eyes (40%) showed a continued remodeling after surgery with significant improvement in the appearance of foveal microstructure and foveal contour. The other six eyes did not demonstrate this positive change. The most significant change was seen in patient 4 in whom over a 16 month followup period, an obvious defect in the outer retina was noted to become gradually smaller and eventually disappeared. This study confirms earlier reports that significant remodeling of the foveal microstructure may occur over a long period of time in some of the macular hole eyes after an inverted ILM flap surgery. However, a majority of the eyes did not show this further positive change. The factors responsible for remodeling in some of these eyes, which may be associated with wound healing, ought to be further investigated.
Okonkwo Ogugua Ndubuisi works as a Consultant Vitreoretina Surgery at the Eye Foundation Retina Institute and is the Residency Program Director of the Eye Foundation Ophthalmic Residents Training Program. He also is a Trainer of Vitreoretina Fellows. He has published in several reputable scientific journals and is a Reviewer for over 30 scientific journals.
E-mail: o_okonkwo@yahoo.com