Epiretinal membrane from Uncontrolled gliosis following Inverted ILM Flap technique for Idiopathic Macular Hole

Author: Deependra Vikram Singh (India)

Co-authors: Raja Rami Reddy, Yog Raj Sharma, Awaneesh Upadhyay

Purpose

To describe 2 unusual cases with epiretinal membrane from uncontrolled gliosis that was seen after multilayered inverted ILM flap technique for full thickness macular hole (FTMH).

Setting/Venue

We describe 2 eyes with full thickness macular hole that developed postoperative ERM following an uneventful surgery with multilayered ILM flap technique. Both patients had Metamorphosia and one of these eyes underwent re-surgery for ERM. ERM can be a rare and undesirable effect of excessive gliosis induced by ILM flaps.

Methods

We examined 2 eyes with FTMH who have undergone surgery with inverted ILM flap technique. Serial OCT scans were done to evaluate the course of foveal hyperreflective lesions observed in these eyes. OCT features analyzed were architecture of inner retinal layers and restoration of outer retinal layers. We also retrospectively analyzed the postoperative OCTs of 38 consecutive eyes with FTMH that were operated by inverted ILM flap technique by same surgeon (DVS).

Results

Both eyes demonstrated multiple layers of ILM flap visible as hyperreflective structures over fovea. On serial follow up, we observed excessive uncontrolled gliosis from these hyperreflective ILM flaps that resulted in ERM formation. Both patients reported worsening of Metamorphosia and decline in best corrected visual acuity (BCVA). Case 1 had to undergo a repeat surgery for removing ERM. We could also observe similar hyperreflective ILM flaps over fovea in 34 out of 38 eyes. The ILM flaps in all but the 2 eyes described above were stable and did not show progression or gliosis at final follow up period not less than six months.

Conlusions

We report excessive uncontrolled gliosis as a rare complication of multilayered inverted ILM flap technique for FTMH that resulted in ERM formation and adversely affected visual outcome following Surgery.

Financial Disclosure

NO FINANCIAL DISCLOSURE