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Abstract This work aims to compare anatomical and functional outcomes between multilayered inverted flap technique and conventional ILM peeling in idiopathic macular hole Patient and methods 30 eyes with idiopathic macular hole were included.the study was conducted in the ophthalmology department of Menofia University Hospital after obtaining approval from the hospital ethics committee from june 2022 to june 2023. The surgical procedure and potential complications were explained to all patients after obtaining informed consent. Inclusion criteria: Patients with idiopathic macular hole Exclusion criteria: Patient refused, Poor cooperation, Diabetic, Myopic patients,Uveitic, Traumatic macular hole patients All patients were subjected to (1) Full history taking: Age & sex. Onset, course and duration of the complaint. Past history. (2) Clinical examination: *BCVA was measured using Snellen chart converted to decimal notation for better statistical analysis Macular hole by clinical examination using slit lamp biomicroscopy with Volk 90 D and Full ophthalmological examination including IOP measurement using Goldmann applanation tonometer (3) Investigation; Pre-operative Optical Coherence Tomography. All macular holes were staged based on recent OCT-based classification [Duker et al., 2018], and only full thickness macular hole, grade 2 to 4, were considered for the study. Retinal images were aquired using Spectralis SDOCT (Heidelberg Engineering, Heidelberg®, Germany), Measuring of base diameter, minimal diameter, macular hole index was done. Pre-operative Multifocal Electroretinography; (MonPack One Metrovision technology) was used for mfERG recording, the recording procedures was the same as those described by the International Society for Clinical Electrophysiology of Vision [Hood et al., 2012], the stimulus consisted of 61 hexagons that scale concentrically and covered the central 25 degrees of the fundus area. The viewing distance was 29 cm, which allowed a viewing angle of approximately 30 degrees. Each hexagon was modulated temporally between black (2 cd/m2) and white (200 cd/m2). Pupils were dilated with tropicamide and phenylephrine hydrochloride. The patient wore his spectacle corrected for near. After topical anesthesia, a contact H-K loop electrode was placed, and signals were recorded. During the recordings, the patients‟ fixations were monitored. The signal was amplified (100,000) and band pass was filtered (10–300 Hz). Three dimensional topography represents the retinal response density (amplitude per retinal area, nV/deg2). The mean simultaneous response was recorded. The typical waveform of the basic mfERG response is a biphasic wave with an initial negative deflection followed by a positive peak. Implicit times (latencies) and the amplitude relative to their respective areas nV/deg2) of the first negative peak (N1) and the first positive peak (P1) were measured using regional averages derived from 5 concentric rings. Three-dimensional topography represents the retinal response density (amplitude per retinal area, nV/ deg2). The studied field contained 61 hexagons in 5 rings within a field diameter of 25 degrees, 12.5 degrees radially centered on the fovea and were analyzed with Mon Pack One software. Five rings correspond to 5-degree areas. Only ring 1 and ring 2 considered, as they roughly parallel a 3 mm diameter ILM peel during surgery. Multifocal ERG recorded preoperatively and at 3 months after surgery. |