Internal Limiting Membrane Transplantation Research Articles

Shortfalls of free autologous internal limiting membrane transplantation for highly myopic refractory macular holes in a long term follow-up.

The aim of this study is to evaluate long-term anatomical and functional outcomes of autologous internal limiting membrane (ILM) transplantation in refractory highly myopic macular holes (HMMHs). Retrospective interventional analysis of 13 eyes with refractory HMMH undergoing autologous ILM transplantation with gas tamponade. Best-corrected visual acuity (BCVA, Snellen), optical coherence tomography and fundus photography were scheduled at baseline and every follow-up visit (1, 3, 6, 12, 18, 24 months and the most recent). Preoperatively, we collected minimum linear diameter (MLD) and basal diameter (BD). Post-operatively, rates of external limiting membrane (ELM)/ellipsoid zone (EZ) restoration, excessive gliosis and subfoveal retinal pigmented epithelium (RPE) atrophy were evaluated. Average AXL was 31.45 ± 2.07mm and mean follow-up was 47.2 ± 31.4 months. Anatomical success was reached in 7/13 eyes (54%), while 2 cases showed persisting HMMH, 2 cases had early recurrence and 2 cases late recurrence. BCVA went from 0.19 ± 0.18 to 0.22 ± 0.20 at final follow-up (p = 0.64), improving in 5/13 eyes (38%). One eye showed continuous ELM and EZ lines, while another eye showed an irregular ELM but no EZ. Post-operatively, 5 eyes (71%) developed progressive atrophy of the subfoveal RPE, while excessive gliosis was reported in 3 eyes (43%). Furthermore, one patient developed post-operative chronic macular edema-like changes in the perifoveal area. Autologous ILM transplantation showed controversial anatomical outcomes and and poor visual results in refractory HMMH. Moreover, progressive subfoveal patchy atrophy and excessive gliosis are possible post-operative complications.

Autologous internal limiting membrane transplantation achieves anatomic closure and functional improvement in the treatment of large, persistent macular holes

PurposeTo evaluate the clinical outcome of subretinal autologous internal limiting membrane (ILM) transplantation during pars-plana vitrectomy for persistent full-thickness macular hole (FTMH) repair.MethodsRetrospective, consecutive case series of 13 eyes (13 patients) undergoing small-incision vitrectomy with ILM transplantation and air tamponade for large persistent FTMH after prior unsuccessful vitrectomy with posterior hyaloid detachment and ILM peeling.Main outcome measurementsFor all eyes, high-definition spectral domain optical coherence tomography scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery, 1 and 4 weeks after surgery, and at the final follow-up visit. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best‐corrected visual acuity (BCVA) at baseline, 1 and 4 weeks after surgery, and at the final follow-up visit were analyzed.ResultsAnatomic closure was achieved in all 13 cases (100% success rate). Closure pattern was classified in accordance with to Rossi et al. (Graefe’s Arch Clin Exp Ophthalmol 258(12):2629–2638, 2020). Mean baseline BCVA logMAR was 0.93, mean postoperative BCVA logMAR was 0.66 with a mean postoperative follow-up period of 11.4 months. No re-opening occurred during the observation period.ConclusionsPlacing an autologous ILM-transplant in the subretinal space beneath the margin of the FTMH can support anatomic restauration and functional improvement in large, persistent FTMHs.

Commentary: To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.

Commentary: To evaluate the functional and anatomical outcomes for autologous retinal autograft with Finesse™ Flex Loop for failed macular holes.

Evaluation of Vision-Related Quality of Life after Autologous Internal Limiting-Membrane Transplantation for Refractory Macular Holes.

PurposeTo evaluate the vision-related quality of life of vitrectomy combined with autologous internal limiting membrane (ILM) transplantation for refractory macular holes (MHs).MethodsThere were 40 eyes with refractory MHs included, and all eyes received 23 G vitrectomy and ILM peeling with autologous ILM transplantation. Preoperative and postoperative basic conditions were recorded. The Chinese version of the vision-related quality-of-life scale was used to evaluate patients after operation. Quality of life, postoperative visual acuity, and size of MHs before operation were assessed with Spearman rank correlations.ResultsAll patients were followed up for 3 months after surgery. Mean postoperative best-corrected visual acuity had significantly improved after surgery. Vision-related quality of life of patients after surgery was closely related to the MH index, but negatively correlated with best-corrected visual acuity before and after surgery.ConclusionThe anatomical structure of refractory MHs with ILM peeling combined with autologous ILM transplantation was largely reduced, and the visual acuity of patients improved significantly.

Management of a Macular Hole Following Retinal Arterial Macroaneurysm Rupture

Patient: Female, 60-year-oldFinal Diagnosis: Macular hole following retinal arterial macroaneurysm ruptureSymptoms: Sudden loss of central visionMedication: —Clinical Procedure: 25-gauge pars plana vitrectomySpecialty: OphthalmologyObjective:Unusual clinical courseBackground:We report the successful treatment of a macular hole (MH) secondary to a retinal macroaneurysm (RAMA) rupture by pars plana vitrectomy (PPV) and autologous transplantation of an internal limiting membrane (ILM) during primary surgery.Case Report:A 60-year-old woman presented with a sudden loss of central vision in her right eye. Fundus examination revealed a large sub-ILM hemorrhage involving the macula in her right eye. We performed 25-gauge PPV and ILM peel overlaying the hemorrhage. A ruptured RAMA next to the inferotemporal branch of the central retinal artery, MH, and subretinal hemorrhage were discovered. Part of the subretinal blood clot was removed through the MH. ILM was then further peeled off outside vascular arcades and transplanted as a free flap into the MH. At the end of surgery, 10% C3F8 gas was instilled as tamponade.Postoperatively, we observed anatomical closure of the MH, restoration of outer retinal layers, and improvement of visual acuity. During the follow-up period, the patient also had cataract surgery. Two years after the vitrectomy, the MH remained closed, with visual acuity improved to 10/20.Conclusions:Autologous ILM transplantation during primary PPV can be an effective surgical approach for treatment of MH related to ruptured RAMA in selected cases.

Effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole

Objective To observe the effect of internal limiting membrane peeling and transplantation on vision-related quality of life in refractory macular hole. Methods A retrospective clinical study. Thirty patients (30 eyes) with refractory macular hole diagnosed in Ophthalmology Department of The First Affiliated Hospital of Nanjing Medical University from January to December 2016 were included in this study. There were 13 males (13 eyes) and 17 females (17 eyes), with the mean age of 57.3±6.9 years. There were 15 patients(15 eyes) with large macular diameter, 12 patients (12 eyes) with high myopia macular hole, and 3 patients (3 eyes) with secondary traumatic macular hole. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. OCT was performed to measure the macular retinal thickness (CRT), base diameter and minimum diameter of macular hole. Then, the macular hole index(MHI) was calculated. The logMAR BCVA was 1.52±0.30, MHI was 0.51±0.19. The Chinese version of visual-related quality of life scale-25 (CVRQoL-25) was used to evaluate the vision-related quality of life of patients. The CVRQoL-25 score was 57.60±7.13. All patients underwent 23G vitrectomy combined with inner limited membrane peeling and autologous ILM transplantation. The follow-up was at least 3 months after surgery. The changes of BCVA, MHI, CRT and CVRQoL-25 score before and after surgery were comparatively analyzed. Paired t test was performed to compare the measurement data before and after surgery, and Spearman rank correlation analysis was used for the correlation analysis among the parameters. Results At 3 months after surgery, the hole closure was detected in 28 eyes (93.3%), not detected in 2 eyes (6.7%). The logMAR BCVA was 1.16±0.33, CRT was 161.00±15.26, and CVRQoL-25 scores was 70.83±9.77. Compared with before surgery, the BCVA (t=4.386, P=0.000) and CVRQoL-25 score (t=-5.991, P=0.000) after surgery were improved. Spearman rank correlation analysis showed that CVRQoL-25 score was negatively correlated with preoperative and postoperative logMAR BCVA (r=−0.536, −0.796; P=0.002, 0.000); positively correlated with preoperative MHI (r=0.421, P=0.020) and postoperative CRT (r=0.589, P=0.001). Conclusion Internal limiting membrane peeling and transplantation for refractory macular hole can significantly improve the vision-related quality of life and visual acuity, while achieved a high hole closure rate (93.3%). Key words: Retinal perforations/surgery; Vitrectomy; Internal limiting membrane peeling; Internal limiting membrane transplantation; Vision-related quality

Free autologous internal limiting membrane transplantation in the treatment of large macular hole.

We evaluated the clinical efficacy of free internal limiting membrane (ILM) flap transplantation for the treatment of large macular hole over 500 µm in 42 consecutive patients. Quantified evaluation of the post-operative macular anatomy restoration was performed by spectral-domain optical coherence tomography in the 12mo follow-up. The results showed 41 eyes achieved successful closure (97.6%). Postoperative best corrected visual acuity, ellipsoid layer, and external limiting membrane disruption were significantly improved at all follow-up time points. The central foveal thickness was significantly higher at 1mo. We concluded that free ILM flap transplantation proves to be effective to achieve anatomical and functional improvement for the treatment of large macular hole.

Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit

Purpose: To compare the anatomical and functional outcome of adjuvant pars plana vitrectomy (PPV) procedures using the techniques of translocation of an internal limiting membrane (ILM) flap and transplantation of an inverted ILM flap for the treatment of chronic and/or refractory optic disc pit (ODP) maculopathy. Methods: In this prospective interventional case series study, 9 patients (9 eyes) with chronic and/or refractory ODP maculopathy underwent PPV with either translocation of an ILM flap or transplantation of an inverted ILM flap as adjuvant techniques along with gas tamponade. The anatomical success, rates of macular reattachment, and visual improvement were assessed. Results: The mean preoperative central retinal thickness (CRT) was 723.4 µm (range: 366–1,151). The mean postoperative CRT was 398.1 ± 212.2 µm (range: 210–758). An increased preoperative CRT was associated with a lower chance of postoperative reattachment of the macula (p = 0.047). The overall reattachment rate at the end of the follow-up period was 56% (n = 5). The mean preoperative visual acuity (logMAR unit [Snellen acuity]) was 0.48 (20/60) (range: 1.30 [20/400] to 0.10 [20/25]). The mean change in best corrected visual acuity (BCVA) was 0.48 ± 0.233 logMAR units (approx. 3 lines of visual improvement). Conclusions: ILM flap techniques are logical and straightforward approaches as adjuvants to PPV treatment of ODP maculopathy. They could be viable adjuvant treatments for improvement in BCVA and CRT in patients with ODP maculopathy.

Clinical observation of treatment of idiopathic macular hole with internal limiting membrane transplantation combined with temporal flap turnover and air filling.

Clinical observation of treatment of idiopathic macular hole with internal limiting membrane transplantation combined with temporal flap turnover and air filling.

Autologous Neurosensory Retinal Transplantation for Unclosed and Large Macular Holes

Purpose: The aim of this study was to demonstrate the surgical technique and clinical outcome of autologous neurosensory retinal patch transplantation for recurrent large macular hole (MH)-induced retinal detachment after failed surgery with internal limiting membrane (ILM) removal or transplantation. Methods: We reviewed 5 patients with recurrent MH-induced retinal detachment after failed surgeries with ILM removal or transplantation who underwent vitrectomy combined with autologous neurosensory retinal patch transplantations and were followed up over 6 months. In the autologous neurosensory retinal patch transplantation procedure, a small piece of neurosensory retina was removed and transplanted inside the MH. The anatomic outcomes of MH-induced retinal detachment were evaluated by fundus examinations and optical coherence tomography. The pre­operative and postoperative best-corrected visual acuities (BCVAs) were compared and the MH closure rates were measured as the main outcomes. Results: A total of 5 patients (3 men and 2 women; average age 35.4 ± 18.72 years) were included in our study. Complete MH sealing was achieved in 5 eyes after autologous neurosensory retinal patch transplantations, and no complications were observed. The mean BCVA was 2.38 ± 0.57 (range 1.6–3) before surgery, and 1.46 ± 0.51 (range 1–2) at 6 postoperative months. There was a significant difference in BCVA before versus after the surgery (p < 0.05, paired t test). Conclusions: Autologous neurosensory retinal patch transplantation is an effective addition to the surgical options for large MH-induced retinal detachment after failed surgery with ILM removal or transplantation.

Treatment of refractory giant macular hole by vitrectomy with internal limiting membrane transplantation and autologous blood.

To investigate the effect of internal limiting membrane transplantation and autologous blood on treating refractory giant macular hole. Thirty-seven eyes with giant macular hole of the smallest hole diameter >700 µm, the maximum diameter of the substrate >1000 µm and hole formation factor <0.6 underwent surgical treatment. The patients were randomly divided into two groups. Nineteen eyes with surgical flip of the internal limiting membrane in group A, 18 eyes with internal limiting membrane transplantation in group B who underwent the tamponade of internal limiting membrane into the hole, autologous plasma was used to seal the hole. The patients were followed up for 3mo, optical coherence tomography and best corrected visual acuity (BCVA) were recorded before and after operation, and the results were statistically analyzed. At 3mo after operation, BCVA of the two groups was significantly improved compared with that before operation (tA=4.192, tB=4.374, P<0.05). But there was no significant difference in visual acuity between the two groups (χ2=0.128, P>0.05). At 3mo after operation, the closure rate of group A was 68.4%, and 100% in group B. (χ2=5.628, P<0.05). The defect diameter of inner segment/outer segment at 3mo after the operation was significantly lower than that before operation (tA=12.287, tB=15.481, P<0.05), and the difference was statistically significant (t=2.552, P<0.05). Internal limiting membrane transplantation combined with autologous whole blood can improve the postoperative closure rate of the refractory large aperture, and can effectively improve the postoperative visual acuity.

This issue of ACTA

This issue of ACTA

Vitrectomy combined with internal limiting membrane annular peeling and transplantation for the treatment of idiopathic macular hole

Objective To investigate the efficacy of internal limiting membrane (ILM) annular peeling and transplantation in the treatment of giant idiopathic macular hole. Methods Data of 52 eyes of 52 cases with giant idiopathic macular hole(d>500 μm) from Jul.2015 to Dec.2016 were collected and analyzed retrospectively. They were divided randomly into 2 groups: group A, 25 cases, underwent pars plana vitrectomy combined with ILM peeling, and group B, 27 cases, received vitrectomy combined internal limiting membrane peeling and transplantation. After surgery the follow-up time was more than 3 months. Results The visual acuity at 3 months after surgery was 0.86±0.27 in group A and 0.62±0.16 in group B. The difference was statistically significant(t=4.000, P=0.030). Macular hole closure rate was 84% in group A and 100% in group B. The difference was statistically significant(χ2=4.680, P=0.047). Defect of ellipsoid zone was (842.08±146.64)μm in group A and (513.89±85.59)μm in group B. The difference was statistically significant(t=6.920, P=0.010). Conclusion Vitrectomy combined with annular ILM peeling and transplantation for the treatment of giant idiopathic macular hole can increase the rate of macular hole closure and improve the visual function. Key words: Retinal perforations; Vitrectomy; Peeling, limiting membrane, internal, annular; Transplantation, limiting membrane, internal

Functional and Anatomic Outcomes of Primary and Secondary Internal Limiting Membrane Transplantation in Large and Persistent Macular Holes

The gold standard therapy for full-thickness macular holes (FTMH) is vitrectomy (PPV) with peeling of the internal limiting membrane (ILM), gas tamponade of the vitreous cavity and postoperative face-down positioning. Nevertheless, eyes with large macular holes (> 400 µm) and surgical failures remain difficult to manage. Recently, ILM transplantation (ILM-TX) techniques were developed with acceptable results, advocating different mechanisms of hole closure: in such a setting, the ILM could serve as a scaffold for neuronal tissue in the pedicle ILM flap technique or the ILM could induce a contraction of the FTMH rims through shrinking of a folded ILM plug. This retrospective study evaluates the functional and anatomic outcomes following ILM-TX for large FTMH and failed FMTH surgery. Large holes (group 1) were treated by the pedicle flap and the plug technique. Persistent holes following vitrectomy and ILM peeling (group 2) were treated with the plug technique. All ILM-TX were performed under perfluorocarbon liquid (PFCL) with a subsequent silicone oil tamponade. In group 1 (6 eyes), three eyes had a free ILM graft and three eyes underwent a pedunculated ILM-TX. The mean best corrected visual acuity (BCVA, LogMar) before primary ILM-TX was 1.18 ± 0.54 with a mean initial hole size of 681 ± 106 µm and a photoreceptor defect (PRD) of 1829 ± 474 µm. Five of six eyes showed a postoperative anatomical macular hole closure (83%). The mean BCVA after a mean follow-up of 9.3 ± 5.1 months was 0.83 ± 0.31 after a free ILM graft and 0.95 ± 0.79 after a pedunculated ILM flap. The PRD reduced to 1781 ± 713 µm after a free ILM graft and 1148 ± 378 µm after a pedunculated ILM flap. In group 2 (7 eyes), all patients had failed initial macular hole surgery closure. Prior to free ILM-TX BCVA was 1.05 ± 0.41, the hole size was 433 ± 183 µm and PRD was 2012 ± 718 µm. After a mean of 9.6 ± 4.1 months following ILM-TX, in six of seven eyes the FTMH hole was closed (86%), BCVA improved to 0.53 ± 0.34 and the PRD shortened to 843 ± 291 µm. In most cases, with large FTMH or holes after failed vitrectomy plus ILM peeling, ILM-TX allows a hole closure. Functional outcomes show stabilization and sometimes even a slight improvement.

Clinical efficacy evaluation of vitrectomy combined with autologous internal limiting membrane transplantation for large macular hole

Background Giant idiopathic macular hole (IMH) severely affects visual acuity and increases operative difficulty during the surgery, so modifying or optimizing the operation method is helpful for improving the prognosis. Objective This study aimed to evaluate the efficacy and safty of vitrectomy combined with free internal limiting membrane transplantation for large IMH. Methods A prospective serial cases-observational study was carried out under the informed consent of each patient.Forty-two eyes of consecutive 42 patients with IMH of mean diameter (814.31±112.95)μm were included in the Second Hospital of Hebei Medical University from January 2013 to November 2015.All the eyes received vitrectomy combined with free internal limiting membrane transplantation and 12% C3F8 filling.The best corrected visual acuity (BCVA) (LogMAR), inner segment/outer segment (IS/OS) defect range, external limiting membrane defect range, retinal thickness at macular fovea were measured with slit lamp microscope, indirect ophthalmoscope and spectral-domain optical coherence tomography (SD-OCT) before surgery and 1, 3, 6 and 12 months after surgery. Results IMH complete closure in 97.6% eyes (41/44) at 12 months after surgery.BCVA was improved after operation and showed a significant difference among various time points (F=28.032, P<0.001). The IS/OS defect range was (1 112.00±45.44), (859.00±84.55), (649.00±52.47), (486.00±46.88) and (320.00±45.13)μm before surgery and 1, 3, 6 and 12 months after surgery, showing a significant difference among different time points (F=38.761, P<0.001), and the IS/OS defect range was gradually shrinked after operation compared with that before operation (all at P<0.05). The mean defect range of external limiting membrane was (1 038.00±39.63), (748.00±64.12), (585.00±48.88), (438.00±42.84) and (265.00±28.97)μm before surgery and 1, 3, 6 and 12 months after surgery, with a significant difference among various time points (F=36.459, P<0.001), and the mean defect range of external limiting membrane was evidently reduced (all at P<0.05). The foveal retinal thickness value was increased at 3, 6 and 12 months after surgery, which was significantly higher than that 1 month after surgery (all at P<0.05). The high reflect signal was faded away at 3 months after operation, indicating that implanted internal limiting membrane was decomposed and metabolized. Conclusions Vitrectomy combined with autologous internal limiting membrane transplantation seems to be safe and effective for large IMH. Key words: Retinal perforations/surgery; Macula; Vitrectomy; Basement membrane/surgery; Treatment outcome; Internal limiting membrane transplantation

Research progress of internal limiting membrane peeling technique

Internal limiting membrane (ILM) peeling technique has been widely used in the treatment of a variety of vitreoretinal diseases for the advantage of releasing vitreomacular traction.However, this routine approach was less effective in refractory macular disorders.Meanwhile, the technique and the use of stains could lead to structural and functional changes of macular.Therefore, to better preserve macular structure, modified ILM peeling techniques including inverted ILM flap technique, autologous transplantation of ILM technique and the foveola nonpeeling ILM technique emerged.Recent researches had demonstrated favorable structural and functional outcomes of these techniques on giant macular hole, refractory macular hole and high myopic macular hole.However, more long-term follow-up studies with larger samples are needed to confirm the current results.In this paper, we reviewed the progress of modified ILM peeling technique in vitreoretinal diseases. Key words: Internal limiting membrane peeling; Inverted internal limiting membrane flap; Autologous transplantation of the internal limiting membrane; Foveolar nonpeeling internal limiting membrane

Hyper-proliferation of Glial Tissues Following Autologous Internal Limiting Membrane Transplantation in Idiopathic Large Macular Holes

Hyper-proliferation of Glial Tissues Following Autologous Internal Limiting Membrane Transplantation in Idiopathic Large Macular Holes

Modified technique of autologous transplantation of the internal limiting membrane for macular hole

Abstract Background Autologous internal limiting membrane transplantation has allowed some cases of macular holes refractory to conventional surgery techniques to be treated. The purpose of this study is to describe the anatomical and functional outcomes of a modification of this technique in a case series of naive macular hole patients. Material and methods A consecutive case series study was performed on patients with naive macular holes with a diameter greater than 600 μm. Best corrected visual acuity, clinical features of the macular area, and optical coherence tomography were recorded before the operation and at the end of follow-up in all patients studied. All patients underwent 23 Ga core vitrectomy, posterior hyaloid separation, and brilliant-blue assisted internal limiting membrane peeling. A small piece of the internal limiting membrane was peeled off to make a free flap, and this was transplanted and placed inside the macular hole under perfluorocarbon liquids. Air–fluid exchange was performed and SF6 gas was injected at a non-expansile concentration. Results The study included 5 eyes of 5 patients who underwent internal limiting membrane autograft. The mean age was 50.6 (SD 12.3) years. Four of the 5 cases had macular hole closure. The case where there was no closure of the macular hole was secondary to trauma. There was an improvement in visual acuity in all patients where the closing of the macular hole was achieved at the end of follow-up. Conclusions In this cases series of macular hole patients, the autologous internal limiting membrane transplantation was associated with an anatomical closure of the macular hole and functional improvement in most of the patients studied.

The changes of macular microstructure in large idiopathic macular hole after vitrectomy combined with internal limiting membrane transplantation or internal limiting membrane peeling

Objective To observe the different changes of macular microstructure in patients with large idiopathic macular hole (IMH) treated with vitrectomy combined with internal limiting membrane (ILM) transplantation or not. Methods Forty eyes in 40 consecutive patients with giant IMH (≥500 μm) were included in the study. Twenty eyes received vitrectomy with ILM transplantation (ILM transplantation group) and others with ILM peel off (ILM removal group). During the operation, a proper size of the ILM was removed and filled in the bottom of the macular hole. The age, duration of disease and the ocular laterality of the two groups of patients were not statistically significant (P>0.05). Minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA) and frequency domain optical coherence tomography (SD-OCT) scan were examined. There was no statistically significant difference in logMAR BCVA, average defect diameter of photoreceptor ellipsoid (IS/OS) and average defect diameter of external limiting membrane (ELM) between two groups (t=0.128, 1.452, 1.321; P>0.05). The logMAR BCVA and SD-OCT were examined on 1, 3, 6, 12 months postoperatively. Results On 1 month after the surgery, there was no statistically significant difference in logMAR BCVA, average defect diameter of IS/OS and average defect diameter of ELM between two groups (t=1.226, 1.435, 1.018; P>0.05). On 3, 6, 12 months after the surgery, compared with ILM removal group, the logMAR BCVA (t=2.059, 2.871, 2.415) increased and the average defect diameter of IS/OS (t=2.070, 2.110, 2.121) and ELM (t=2.034, 3.647, 3.556) significantly reduced in ILM transplantation group (P 0.05). Conclusion Compared with vitrectomy combined with ILM peeling surgery, the diameter of IS/OS and ELM defect were significantly decreased after vitrectomy combined with ILM transplantation in the patients with large IMH. Key words: Retinal perforations/surgery; Vitreoretinal surgery; Macula lutea/physiopathology

The development of surgery for macular hole with retinal detachment in high myopic eyes

Treatment of macular hole associated retinal detachment in high myopia has progressively evolved over the years, including the scleral buckling, simple intravitreal gas injection, pars plana vitrectomy (PPV), PPV combined with internal limiting membrane (ILM) peeling or transplantation and so on. Simple vitreous gas injection is less traumatic and good for the patients with small holes and localized retinal detachment. PPV combined with ILM peeling can achieve better treatment effects for small holes with wide retinal detachment. But for large holes with wide retinal detachment, PPV combined with ILM transplantation is necessary to improve the macular holes closure rate. If the ILM has been peeled before, the lens capsule could be a nice substitute for ILM. The scleral surgery can solve the problem of posterior scleral staphyloma and effectively control the elongation of the axial length. However, there is still no one surgery could deal with all the problems of high myopia, we should consider all the circumstances like the size of the macular hole and the range of the retinal detachment to choose the best individualized therapy. Key words: Myopia, degenerative/surgery; Retinal detachment/surgery; Retinal perforations/surgery; Vitreoretinal surgery; Review