Narrator: Here, we have a chronic stage four
macular hole in the right eye.
We aim to create an inverted ILM flap
as an adjunctive to facilitate hole closure.
This video demonstrates the utility of
intraoperative OCT guidance
in confirming proper positioning
of an inverted ILM flap
at the conclusion of a macular hole surgery.
The ILM has been stained with indocyanine green dye
and is being gingerly pealed at 25 gauge core chaps.
so it's to avoid amputating it's adhesions
to the edges of the hole
Here the vitrector hand piece is being used
to carefully amputate the extraneous flaps.
What remains is super temporal flap of ILM.
An intraoperative OCT confirms it's obvious presence.
An air fluid exchange is then performed.
Care is taken to aspirate the fluid
at a location inferonasal relative to the hole
to allow fluidics to compel the ILM flap to cover the hole.
After air fluid exchange,
intraoperative OCT is used to confirm
proper positioning of the flap over the hole.
To allow for comparison intraoperative OCT
under air on the top panel shows the ILM flap
positioned over the macular hole.
Post operative OCT shown at the bottom panel
reveals a closed macular hole with evidence
of an ILM bridge over the pro viola.