Abstract
Purpose To describe a modified technique of internal limiting membrane (ILM) insertion for macular hole- (MH-) associated retinal detachment (RD) in highly myopic eyes. Methods Nine eyes underwent pars plana vitrectomy, cortical vitreous removal, and fovea-sparing ILM peeling. Double ILM insertion into the hole was performed with inverted perifoveal ILM and a free ILM flap followed by air-fluid exchange. Results Two of the 9 eyes had perifoveal ILM partially torn after cortical vitreous or epiretinal removal. All eyes had the ILM plug stabilized within the MH after double ILM insertion. Postoperatively, MH was sealed with the retina reattached in all the eyes. Conclusion Double ILM insertion may further secure the ILM flap in place in the eyes with MH-associated RD, especially in cases in which insufficient perifoveal ILM was left. This trial is registered with the clinical registration number Clinicaltrials.gov NCT03174639.
Highlights
Macular hole- (MH-) associated retinal detachment (RD) in high myopia poses a specific challenge for the vitreoretinal surgeons
In 20 cases treated with this technique, we were able to achieve a 100% closure rate in highly myopic eyes with MH-associated RD [6]
We have modified the inverted internal limiting membrane (ILM) flap technique [6] by adding another piece of free ILM flap into the hole to address the abovementioned problems. We found that this additional step made the plugging of the ILM tissue faster and the resultant ILM plug much more secure
Summary
Macular hole- (MH-) associated retinal detachment (RD) in high myopia poses a specific challenge for the vitreoretinal surgeons. Covering the ILM flap with a layer of blood has been proposed recently to stabilize the ILM flap [5] We proposed another technique by inserting the inverted perifoveal ILM about 1.5 disc diameter in size into the hole to facilitate hole closure. We have modified the inverted ILM flap technique [6] by adding another piece of free ILM flap into the hole to address the abovementioned problems. We found that this additional step made the plugging of the ILM tissue faster and the resultant ILM plug much more secure. We reported a small case series using this modified inverted ILM flap insertion technique; details of the surgical techniques were described
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