Sub-perfluoro-n-octane injection of ocular viscoelastic device assisted inverted internal limiting membrane flap for macular hole retinal detachment surgery: a novel technique

Chi-Chun Lai,Yen-Po Chen,Kuan-Jen Chen,Wee Min Teh,Hung-Da Chou,An-Lun Wu,Laura Liu,Wei-Chi Wu,Yih-Shiou Hwang

doi:10.1186/s12886-020-01393-1

Abstract

BackgroundTo evaluate the feasibility of a surgical technique using a sub-perfluoro-n-octane (PFO) injection of ocular viscoelastic device (OVD) to stabilize inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD).MethodsThis study was a retrospective, consecutive, interventional case series. Patients who underwent MHRD surgery with sub-PFO injection of OVD to stabilize inverted ILM flap onto the macular hole (MH) were reviewed. The color fundus and optical coherence tomography (OCT) images were collected and evaluated. The best-corrected visual acuity (BCVA) before and after surgery were compared as the functional outcome.ResultsThe study included 8 eyes of 8 consecutive patients (mean age: 61.8 ± 7.1 years; mean follow-up period: 9.0 ± 2.5 months). All eyes (100%) achieved successful MH closure; 7 eyes (87.5%) demonstrated complete retinal reattachment, and 1 eye (12.5%) had minimal residual subretinal fluid parafoveally. Of the 8 patients, 7 patients (87.5%) had achieved improvement in BCVA after the primary surgery, whereas 1 eye remained stable. The average BCVA before and after the surgery at the last visit improved from 20/843 (1.63 ± 0.48 logMAR) to 20/200 (1.00 ± 0.39 logMAR) (P = 0.016). Anatomically, near-normal foveal contour was noted in five (62.5%) eyes at the final follow-up.ConclusionsThe use of sub-PFO injection of OVD in MHRD surgery could stabilize inverted ILM flaps, achieve good anatomical results and improve postoperative BCVA.

Highlights

To evaluate the feasibility of a surgical technique using a sub-perfluoro-n-octane (PFO) injection of ocular viscoelastic device (OVD) to stabilize inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD)
This study evaluates the feasibility of this technique for MHRD treatment
Patients with MHRD who underwent pars plana vitrectomy (PPV) with sub-PFO inverted ILM flap plus OVD injection technique with a follow-up duration of over 6 months were retrospectively reviewed in this study

Summary

Introduction

To evaluate the feasibility of a surgical technique using a sub-perfluoro-n-octane (PFO) injection of ocular viscoelastic device (OVD) to stabilize inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD). MHRD surgical success has been challenging in terms of retinal attachment and MH closure [1]. MHRD surgical intervention by pars plana vitrectomy (PPV) with an inverted internal limiting membrane (ILM) flap [2] and its modified techniques have been developed to improve retinal attachment and macular hole (MH) closure rate [3–6]. Application of the OVD directly on the ILM flap in an appropriate volume is a technical challenge. A novel technique to position inverted ILM flap and ensure its stabilization to the desirable position is strongly needed

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Results

Discussion

Conclusion