QuizWise 22

Q1. What is inverted Internal limiting membrane (ILM) peeling?
 a) Removing ILM completely around macular hole
 b) Removing ILM completely around macular hole nearly 2 disc diameters in size
 c) Removing ILM around macular hole nearly 2 disc diameters in size and leaving the edges of ILM to tuck into the hole
 d) None of the above

Q2. What is the mechanism of macular hole closure in inverted ILM peel technique?
a) It provides a smooth and gap-free natural scaffold for the migration of glial cells and photoreceptors towards the fovea.
b) Neurotrophic and growth factors retained on the surface of the ILM flap enhanced the proliferation and migration of the muller cells.
c) Both a and b
d) None of the above

Q3. Broad Vitreo macular traction is defined as?
a) Vitreous attachment to the macular surface as measured by OCT, with attachment of 1500 μm or less.
b) Vitreous attachment to the macular surface as measured by OCT, with attachment of more than 1500 μm.
c) Vitreous attachment to the macular surface as measured by OCT, with attachment of 1000 μm or less.
d) Vitreous attachment to the macular surface as measured by OCT, with attachment of more than 1000 μm.

Q4. What is the size of Large Full thickness macular hole?
a) ≥400 μm
b) ≥350 μm
c) ≥300 μm
d) ≥250 μm

Q5. Lamellar macular hole is differentiated from Full thickness macular hole by?
a) Presence of intact photo receptor layer
b) Presence of retinoschisis
c) Defect in inner plexiform layer
d) All of the above

Answers

Ans.1.
c) Removing ILM around macular hole nearly 2disc diameters in size and leaving the edges of ILM to tuck into the hole.

Michalewska et al., first described a novel technique of inverted internal limiting membrane (ILM) flap for the treatment of large macular holes. They found that their technique achieved better anatomical and visual outcomes compared to conventional ILM peeling (ILMP). In last couple of years, a number of studies have suggested that inverted ILM flap technique (IFT) may be better for the treatment of large macular holes.  In the inverted ILM flap group, the margins of the ILM were left attached to the edges of the hole. The margins were later trimmed with the vitrectomy cutter. Only adequate amount of ILM required to tuck into the hole was retained.

Naresh Babu Kannan, et.al Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial. BMC Ophthalmology (2018) 18:177.DOI: 10.1186/s12886-018-0826-y

Ans. 2.
c) Both a and b

It was found that higher anatomical success rate and a better functional outcome was noticed with inverted ILM flap technique. The trend can be explained by the fact that inverted ILM flap technique  provides a smooth and gap-free natural scaffold for the migration of glial cells and photoreceptors towards the fovea. Shiode et al experimentally proved that the neurotrophic and growth factors retained on the surface of the ILM flap enhanced the proliferation and migration of the muller cells. The migrating muller cells secrete neurotrophic factors and growth factors that may promote the survival of retinal neurons and photoreceptor cells. Some markers of cell proliferation like Ki-67 were also found in contact with the inverted ILM flap.

Naresh Babu Kannan, et.al Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial . Kannan et al. BMC Ophthalmology (2018) 18:177doi: 10.1186/s12886-018-0826-y

Ans. 3.
b) Vitreomacular traction can be subclassified by the diameter of vitreous attachment to the macular surface as measured by OCT, with attachment of 1500 μm or less defined as focal and attachment of more than 1500 μm as broad.

The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Duker JS et.al. Ophthalmology 2013 Dec;120(12):2611-2619. doi: 10.1016/j.ophtha.2013.07.042.

Ans. 4.
a) Full-thickness macular hole

Size: small (250 microns), medium (>250 to 400 microns), or large (>400 microns)
The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and Macular Hole

Jay S. Duker et.al AAO December 2013Volume 120, Issue 12, Pages 2611–2619 DOI: https://doi.org/10.1016/j.ophtha.2013.07.042

Ans. 5.
a) Intact photo receptor layer

Lamellar macular hole is associated with loss of foveal contour, retinoschisis, defect in inner fovea and intact photoreceptor layer. However presence of intact photoreceptor layer at base is the differentiating feature.

The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and Macular Hole

Jay S. Duker et.al AAO December 2013Volume 120, Issue 12, Pages 2611–2619 DOI: https://doi.org/10.1016/j.ophtha.2013.07.042

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