Abstract
To compare the efficacy of internal limiting membrane (ILM) flap covering to that of ILM flap insertion for the treatment of macular hole retinal detachment (MHRD) in highly myopic eyes with axial length (AL) ≥ 30 mm. We retrospectively analysed the medical records of 48 MHRD patients with high myopia (AL ≥ 30 mm). According to different surgical methods, the patients were divided into a covering group (23 eyes) and an insertion group (25 eyes). The rate of retinal reattachment and MH closure were compared between the two groups, and the related factors affecting the initial anatomical results were analysed. After primary vitrectomy and single silicone oil removal, there were 18 eyes (78.3%) in the covering group, and 20 eyes (80.0%) in the insertion group had retinal reattachment (P = 1.000). Moreover, 16 eyes (69.6%) in the covering group and 17 eyes (68.0%) in the insertion group had their MHs sealed (P = 0.907). The best-corrected visual acuity (BCVA) at 12 months and the improvement in BCVA postoperatively in the two groups were not statistically significant (P = 0.543, 0.955). Logistic regression analysis showed that elongated AL (OR = 1.844, 95% CI 1.037–3.280, P = 0.037) and higher choroidal atrophy (OR = 2.986, 95% CI 1.011–8.821, P = 0.048) were risk factors affecting initial anatomical success. For extremely high-myopia MHRD with AL ≥ 30 mm, ILM flap covering and insertion can both effectively seal the MH and promote retinal reattachment, but the visual function improvement may still be limited. The longer the AL and the higher the choroidal atrophy, the greater is the risk of initial anatomical failure.
Highlights
To compare the efficacy of internal limiting membrane (ILM) flap covering to that of ILM flap insertion for the treatment of macular hole retinal detachment (MHRD) in highly myopic eyes with axial length (AL) ≥ 30 mm
In 2010, Michalewska et al.[11] first instructed the inverted ILM flap technique mainly used to treat large idiopathic MH (> 400 μm), with an MH closure rate being observed in 98% of cases, which promoted the application of this technique to treat high-myopia MHs with or without RD
There were no significant differences in age, sex, axial length, preoperative lens status, duration of preoperative symptoms, retinal detachment range, posterior scleral staphyloma, or Meta-analysis of Pathologic Myopia (META-PM) classification between the ILM covering group and the ILM insertion group (Table 1)
Summary
To compare the efficacy of internal limiting membrane (ILM) flap covering to that of ILM flap insertion for the treatment of macular hole retinal detachment (MHRD) in highly myopic eyes with axial length (AL) ≥ 30 mm. When the axis of high myopia is seriously stretched to more than 30 mm, the posterior sclera is swollen, the retina is fragile, the choroid retina is atrophied, and the vitreoretinal interface is abnormal and sometimes accompanied by myopic traction macular retinal detachment These characteristics may lead to a poor prognosis of MH surgery. The improvement in visual acuity compared with that in the ILM peeling group was not clear, all the MHs in the ILM insertion group were closed These operations were based on the hypothesis that the inverted ILM flap in the MH was used as a tamponade and acted as a scaffold to correct the anatomical mismatch between the neurosensory retina RPE-choroidal-scleral c omplex[11,13]. More data are needed to determine the efficacy of these two different types of inverted ILM flap techniques during vitrectomy for the treatment of MHRD in highly myopic eyes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
