The Role of Internal Limiting Membrane Flap for Highly Myopic Macular Hole Retinal Detachment: Improving the Closure Rate but Leading to Excessive Gliosis.

Yiqi Chen,Jia Qu,Lijun Shen,Jiafeng Yu,Li Lin,Sulan Wu,Jiwei Tao,Xin Ye,Jun Wang

doi:10.3389/fmed.2021.812693

Abstract

Purpose: To investigate the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique for macular hole retinal detachment (MHRD) in high myopia.Methods: This was a retrospective interventional study on 45 highly myopic eyes with MHRD after ILM peeling (n = 24, peeling group) or the inverted ILM flap technique (n = 21, inverted group). The inverted group was consisted of autologous blood (AB) subgroup (n = 10) and perfluorocarbon liquid (PFCL) subgroup (n = 11). MH closure, best-corrected visual acuity (BCVA), foveal microstructures, and excessive gliosis were analyzed during a follow-up of over 12 months.Results: The inverted group achieved a higher MH closure rate (95.24%) than the peeling group (41.67%; p < 0.001). No significant difference was found in postoperative BCVA between the two groups (p = 0.98) or between the closed MH with or without excessive gliosis (p = 0.60). Excessive gliosis was identified in 9 eyes in the inverted group, and there was no difference in the incidence of excessive gliosis between the AB subgroup (4 in 10 eyes, 40%) and the PFCL subgroup (5 in 11 eyes, 45.45%) (p > 0.999).Conclusion: The inverted ILM flap technique was effective in MH closure but had no advantage in postoperative BCVA and microstructural restoration. Excessive gliosis was only detected in the inverted group but did not affect the postoperative BCVA. Additionally, the incidence of excessive gliosis was not affected by adjuvants.

Highlights

Macular hole retinal detachment (MHRD) is a severe vision-threatening complication of high myopia [1] and accounts for about 38% of the extreme myopia population in China [2]
The tangential traction is associated with the attached cortical vitreous, epiretinal membrane (ERM), hardened internal limiting membrane (ILM), and retinal vessels [5, 6]
A modified inverted ILM flap technique assisted by perfluorocarbon liquid or autologous blood was performed to stabilize the ILM flap

Summary

Introduction

Macular hole retinal detachment (MHRD) is a severe vision-threatening complication of high myopia [1] and accounts for about 38% of the extreme myopia population in China [2]. The underlying mechanism has not been delineated, it is currently accepted that MHRD is caused by the combined action of tangential traction and longitudinal force [3, 4]. Role of ILM in MHRD enlargement of the staphyloma and excessive elongation of the globe, longitudinal force plays a non-ignorable role in separating the neural retina from the retinal pigment epithelium (RPE) [3]. The key to treating MHRD is releasing the tension entirely by removing the posterior hyaloid, ERM, and ILM. After introducing the inverted ILM flap technique, better anatomical success was achieved in recent years [8, 11,12,13]. Previous studies have demonstrated that the inverted flap technique assisted by perfluorocarbon liquid (PFCL) can achieve a better functional and anatomical prognosis [8, 14]. Besides PFCL, autologous blood (AB) containing rich growth factors has been applied in MHRD surgery to facilitate MH closure [15]

Methods

Results

Discussion

Conclusion