Comparative study of success of various techniques of internal limiting membrane peel in the management of rhegmatogenous retinal detachment with proliferative vitreoretinopathy with concomitant macular hole

Abstract

Purpose: To assess the anatomical and functional success in patients with rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) ≥ C1 with coexisting macular holes (MHs) using different management strategies. Materials and Methods: It is a prospective, nonrandomized, observational study in 23 eyes of 23 patients (male: female = 15:8) diagnosed with RRD with PVR ≥ C1 with MH. Patients were divided into three groups according to the technique: Group 1: Pars plana vitrectomy (PPV) without internal limiting membrane (ILM) peel, Group 2: PPV with ILM peel, and Group 3: PPV with inverted ILM peel technique. Results: The closure of MH was confirmed on SD-OCT. Of the total 23 eyes, 19 patients had attached retina with closed MH during a follow-up period of 6 months. Out of four cases of recurrent retinal detachment (RD), three patients belonged to the no peel group and one to the ILM peel group. In no peel group, two patients had recurrence with re-opening of MH, and out of these two cases, one patient had additional break in the periphery. However, two other cases, each from no peel and ILM peel group, had recurrence due to PVR changes in the periphery. Visual acuity (VA) improvement to LogMar ≤ 1 is seen in 50%, 70%, and 85.7% in the no peel, ILM peel, and inverted flap technique, respectively. Conclusion: The results suggest that ILM flap technique without encirclage band can be effectively applied to the treatment of MH with RD with more severe PVR changes and that the hole closure results in improved postoperative best-corrected VA.