Visual Outcomes after Internal Limiting Membrane Peeling vs. Flap in the Closure of Full Thickness Macular Holes.

PURPOSE: To examine postoperative outcomes of internal limiting membrane peeling (ILMP) versus flap (ILMF) in the closure of full thickness macular holes (FTMH). METHODS: Retrospective chart review of patients who underwent pars plana vitrectomy and gas tamponade with ILMP or ILMF to close FTMH at the Atrium Health Wake Forest Baptist from January 2012 to October 2022 with at least 3 months follow up. Main outcome measures were type 1 primary FTMH closure and postoperative best corrected visual acuity (BCVA) in mean logMAR. RESULTS: 130 and 30 eyes underwent ILMP and ILMF respectively. There were no significant differences in baseline characteristics between the groups. 96% of ILMP eyes and 90% of ILMF eyes achieved primary hole closure (p=0.29). Among all eyes with primary hole closure, BCVA at 1 year was not different between the groups but when stratified by lens status, was superior in the ILMP versus ILMF group in pseudophakic eyes: the estimated least-squares mean BCVA (Snellen equivalent) [95% confidence interval] was 0.42 (20/50) [0.34, 0.49] in the ILMP group and 0.71 (20/100) [0.50, 0.92] in the ILMF group. CONCLUSIONS: ILMP and ILMF techniques yielded similarly high FTMH closure rates. In pseudophakic eyes with primary hole closure, ILMF eyes had worse BCVA at 1 year.

The microsurgical safety task force: guidelines for minimizing endophthalmitis with vitrectomy surgery.

PURPOSE OF REVIEW: The transition from 20-gauge vitrectomy surgery to 23-gauge and 25-gauge instrumentation was not without its complications. Early instrumentation provided limitations in surgical technique, including limited illumination, instrument flex, and efficiency of vitreous removal. The most concerning finding arose from two separate retrospective studies which reported increased rates of postoperative endophthalmitis following small-gauge vitrectomy. This situation raised questions as to whether this shift in technique was appropriate. RECENT FINDINGS: Following these concerning reports of complication, a Microsurgery Safety Task Force was convened to evaluate the scientific evidence and create guidelines with the intent to minimize the rates of postoperative infection with small-gauge vitrectomy surgery. Further studies of wound architecture and advances in instrumentation and surgical technique have improved outcomes. More recent studies demonstrate equivalent rates of postoperative endophthalmitis between 20-gauge and smaller gauge instrumentation. SUMMARY: The guidelines of the Microsurgery Safety Task Force, evolutions in instrumentation and surgical technique, and improved understanding of small-gauge vitrectomy wound construction have yielded comparable results in endophthalmitis rates for small-gauge vitrectomy versus traditional 20-gauge approaches.