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Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique

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Title: Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique
Authors: Kase, Satoru Browse this author →KAKEN DB
Saito, Wataru Browse this author →KAKEN DB
Mori, Shohei Browse this author
Saito, Michiyuki Browse this author
Ando, Ryo Browse this author
Dong, Zhenyu Browse this author
Suzuki, Tomohiro Browse this author
Noda, Kousuke Browse this author →KAKEN DB
Ishida, Susumu Browse this author →KAKEN DB
Keywords: inverted ILM flap
glial cells
macular hole
Issue Date: 2017
Publisher: Dove Medical Press
Journal Title: Clinical ophthalmology
Volume: 11
Start Page: 9
End Page: 14
Publisher DOI: 10.2147/OPTH.S119762
Abstract: Purpose: The aims of this study were to analyze optical coherence tomography (OCT) imaging of large macular holes (MHs) treated with inverted internal limiting membrane (ILM) flap technique and to perform a histological examination of an ILM-like membrane tissue obtained during vitrectomy. Patients and methods: This is a retrospective observational case study. Nine patients, comprising of five males and four females, showing large and myopic MHs, underwent pars plana vitrectomy (PPV) with inverted ILM flap technique assisted by brilliant blue G (BBG) staining. Ophthalmological findings including visual acuity and OCT were investigated based on medical records. Formalin-fixed paraffin-embedded tissue section of an ILM-like membrane was submitted for immunohistochemistry with glial fibrillary acidic protein (GFAP). Results: ILM was clearly stained with BBG in eight patients, whereas the ILM in one case revealed no staining with BBG during PPV. Visual acuities improved to >0.2 LogMAR in six patients. The complete closure of MH following PPV with inverted ILM technique was eventually achieved in all patients determined by OCT imaging (100%). Only one patient showed recovery of ellipsoid zone and interdigitation zone following the surgery. Elongation of outer nuclear layer was noted in three eyes. The ILM-like membrane not stained with BBG histologically revealed an amorphous structure admixed with GFAP-positive mononuclear cell infiltration. Conclusion: PPV with inverted ILM flap technique achieved 100% closure rates with favorable configuration at an initial surgery in large MHs. Our histopathological data also suggest that even BBG staining-negative membrane may be a useful material for autologous transplantation to the hole.
Type: article
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 加瀬 諭

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