الفهرس 
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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.