Inverted ILM-flap Techniques Variants for Macular Hole Surgery: Outcomes Comparison

NCT ID: NCT04135638

Last Updated: 2019-10-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

28 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-11-01

Study Completion Date

2020-04-10

Brief Summary

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To report closure rate, Best Corrected Visual Acuity (BCVA), Retinal Sensitivity (RS) and Fixation Stability (FS) of idiopathic Macular Holes (MH) randomized to Cover Group (CG) or Fill Group (FG) of the Inverted Internal Limiting Membrane (ILM) flap surgical procedure.

Detailed Description

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Patients will be randomized (1:1) to receive a vitrectomy with either Cover or Fill ILM flap technique. "Cover" when the ILM flap is everted over the MH gap in a single layer, "Fill" when the ILM is folded into multiple layers within the MH. All patients will undergo BCVA, RS and FS assessment at baseline, 1-month and 3-months after surgery.

Purpose of the study is to report retinal differential sensitivity and fixation stability as well as anatomic and visual outcomes of patients operated on for idiopathic MH and randomly assigned to Fill or Cover Groups.

Conditions

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Macular Holes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Cover Group (CG)

All patients will undergo a 25G standard 3-port PPV with posterior vitreous detachment induction (if not already present), ILM staining with 0,25 g/l of brilliant blue-G and creation of a 360°ILM flap around the MH rim.

Phakic patients will undergo combined phacoemulsification with IOL implant in-the-bag.

In the Cover Group the ILM flap will be folded as a single layer to bridge tissue dehiscence during air-fluid exchange. All eyes will recive a mixture of 20% sulfur hexafluoride tamponade and will be instructed to position face down for 4 hours a day during the first 3 days post-operative

Group Type OTHER

Cover Group

Intervention Type PROCEDURE

"Cover" when the ILM flap is everted over the MH gap in a single layer

Fill Group (FG)

All patients will undergo a 25G standard 3-port PPV with posterior vitreous detachment induction (if not already present), ILM staining with 0,25 g/l of brilliant blue-G and creation of a 360°ILM flap around the MH rim.

Phakic patients will undergo combined phacoemulsification with IOL implant in-the-bag.

In the Fill Group, multiple layers of ILM will be deliberately folded within the loss of tissue before air-fluid exchange. All eyes will receive a mixture of 20% sulfur hexafluoride tamponade and will be instructed to position face down for 4 hours a day during the first 3 days post-operative

Group Type OTHER

Fill Group

Intervention Type PROCEDURE

"Fill" when the ILM is folded into multiple layers within the MH

Interventions

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Cover Group

"Cover" when the ILM flap is everted over the MH gap in a single layer

Intervention Type PROCEDURE

Fill Group

"Fill" when the ILM is folded into multiple layers within the MH

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* patients with idiopatic macular holes

Exclusion Criteria

* Patients with MH duration greater than 6 months
* myopia exceeding 6 diopters
* history of trauma
* previous ocular surgery except uncomplicated cataract extraction with in-the-bag IOL implantation
* any ocular illness including glaucoma, uveitis, optic nerve pathology
Minimum Eligible Age

50 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ospedale Policlinico San Martino

OTHER

Sponsor Role collaborator

Fondazione G.B. Bietti, IRCCS

OTHER

Sponsor Role collaborator

Università degli Studi 'G. d'Annunzio' Chieti e Pescara

OTHER

Sponsor Role collaborator

University of Molise

OTHER

Sponsor Role lead

Responsible Party

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Ciro Costagliola

Full Professor in Ophthalmology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ciro Costagliola

Role: PRINCIPAL_INVESTIGATOR

University of Molise

Locations

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University of Molise

Campobasso, , Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Ciro Costagliola, MD

Role: CONTACT

+390874404448

Facility Contacts

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Costagliola Ciro

Role: primary

08744092269

References

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Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991 May;109(5):654-9. doi: 10.1001/archopht.1991.01080050068031.

Reference Type BACKGROUND
PMID: 2025167 (View on PubMed)

Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 2010 Oct;117(10):2018-25. doi: 10.1016/j.ophtha.2010.02.011. Epub 2010 Jun 11.

Reference Type BACKGROUND
PMID: 20541263 (View on PubMed)

Rossi T, Gelso A, Costagliola C, Trillo C, Costa A, Gesualdo C, Ripandelli G. Macular hole closure patterns associated with different internal limiting membrane flap techniques. Graefes Arch Clin Exp Ophthalmol. 2017 Jun;255(6):1073-1078. doi: 10.1007/s00417-017-3598-9. Epub 2017 Feb 4.

Reference Type BACKGROUND
PMID: 28161828 (View on PubMed)

Molina-Martin A, Perez-Cambrodi RJ, Pinero DP. Current Clinical Application of Microperimetry: A Review. Semin Ophthalmol. 2018;33(5):620-628. doi: 10.1080/08820538.2017.1375125. Epub 2017 Oct 9.

Reference Type BACKGROUND
PMID: 28991503 (View on PubMed)

Chen WC, Wang Y, Li XX. Morphologic and functional evaluation before and after successful macular hole surgery using spectral-domain optical coherence tomography combined with microperimetry. Retina. 2012 Oct;32(9):1733-42. doi: 10.1097/IAE.0b013e318242b81a.

Reference Type BACKGROUND
PMID: 22466479 (View on PubMed)

Bonnabel A, Bron AM, Isaico R, Dugas B, Nicot F, Creuzot-Garcher C. Long-term anatomical and functional outcomes of idiopathic macular hole surgery. The yield of spectral-domain OCT combined with microperimetry. Graefes Arch Clin Exp Ophthalmol. 2013 Nov;251(11):2505-11. doi: 10.1007/s00417-013-2339-y. Epub 2013 Apr 26.

Reference Type BACKGROUND
PMID: 23620091 (View on PubMed)

Chen SN. Large semicircular inverted internal limiting membrane flap in the treatment of macular hole in high myopia. Graefes Arch Clin Exp Ophthalmol. 2017 Dec;255(12):2337-2345. doi: 10.1007/s00417-017-3808-5. Epub 2017 Oct 10.

Reference Type BACKGROUND
PMID: 28993905 (View on PubMed)

Aurora A, Seth A, Sanduja N. Cabbage Leaf Inverted Flap ILM Peeling for Macular Hole: A Novel Technique. Ophthalmic Surg Lasers Imaging Retina. 2017 Oct 1;48(10):830-832. doi: 10.3928/23258160-20170928-08.

Reference Type BACKGROUND
PMID: 29020427 (View on PubMed)

Rizzo S, Tartaro R, Barca F, Caporossi T, Bacherini D, Giansanti F. INTERNAL LIMITING MEMBRANE PEELING VERSUS INVERTED FLAP TECHNIQUE FOR TREATMENT OF FULL-THICKNESS MACULAR HOLES: A COMPARATIVE STUDY IN A LARGE SERIES OF PATIENTS. Retina. 2018 Sep;38 Suppl 1:S73-S78. doi: 10.1097/IAE.0000000000001985.

Reference Type BACKGROUND
PMID: 29232338 (View on PubMed)

Wang Z, Qi Y, Liang X, Yu Y, Chen J, Wang J, Liu X, Liu W. MP-3 measurement of retinal sensitivity in macular hole area and its predictive value on visual prognosis. Int Ophthalmol. 2019 Sep;39(9):1987-1994. doi: 10.1007/s10792-018-1032-x. Epub 2018 Oct 3.

Reference Type BACKGROUND
PMID: 30284091 (View on PubMed)

Sun Z, Gan D, Jiang C, Wang M, Sprecher A, Jiang AC, Xu G. Effect of preoperative retinal sensitivity and fixation on long-term prognosis for idiopathic macular holes. Graefes Arch Clin Exp Ophthalmol. 2012 Nov;250(11):1587-96. doi: 10.1007/s00417-012-1997-5. Epub 2012 Mar 24.

Reference Type BACKGROUND
PMID: 22441811 (View on PubMed)

Tarita-Nistor L, Gonzalez EG, Mandelcorn MS, Lillakas L, Steinbach MJ. Fixation stability, fixation location, and visual acuity after successful macular hole surgery. Invest Ophthalmol Vis Sci. 2009 Jan;50(1):84-9. doi: 10.1167/iovs.08-2342. Epub 2008 Aug 29.

Reference Type BACKGROUND
PMID: 18757517 (View on PubMed)

Cacciamani A, Gelso A, Di Nicola M, Scarinci F, Ripandelli G, Costagliola C, Rossi T. Inverted ILM-flap techniques variants for macular hole surgery: randomized clinical trial to compare retinal sensitivity and fixation stability. Sci Rep. 2020 Sep 28;10(1):15832. doi: 10.1038/s41598-020-72774-1.

Reference Type DERIVED
PMID: 32985592 (View on PubMed)

Other Identifiers

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14738

Identifier Type: -

Identifier Source: org_study_id

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