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Yasutaka Onoda, Tomoaki Shiba, Kenji Sawada, Yuichi Hori, Takatoshi Maeno; Treatment of macular hole with retinal detachment in high myopia by the inverted internal limiting membrane flap technique. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1161.
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© ARVO (1962-2015); The Authors (2016-present)
To assess whether the inverted internal limiting membrane flap technique (ILM flap technique) for idiopathic large macular hole is an effective surgical intervention for the treatment of macular hole with retinal detachment in cases of high myopia.
We analyzed 7 eyes of 7 patients (men:women, 2:5; average age, 67.0 years old) diagnosed with macular hole with retinal detachment in high myopia combined with posterior staphyloma and treated by vitrectomy. The axial lengths of the eyes ranged from 35.6 mm to 27.4 mm and averaged 30.1 mm. All procedures were in full compliance with the guidelines of the Declaration of Helsinki and were approved by the Institutional Review Board/Ethics Committee. All of the eyes underwent 23 gauge system vitrectomy after cataract surgery (3 pseudophakic eyes and 4 aphakic eyes after the surgery). Each procedure consisted of a core vitrectomy followed by the creation of a posterior vitreous detachment, the removal of the vitreous cortex after visualization with triamcinolone acetonide, and ILM staining with Brilliant Blue G. The ILM was peeled off around the macular hole but left attached to the edge of the hole without complete removal from the retina, as described in the report from Michalewska. Upon completion of the surgery, the vitreous cavity was filled with 10% C3F8 and the patient was kept in a prone position for about 4 days. Before and after surgery, the retinal structure of the macula lesion was observed by optical coherence tomography (OCT) to confirm both retinal attachment and macular hole closure.
OCT measurements confirmed complete retinal attachment and initial closure of the macular hole in all of the cases. None of the macular hole reopened and none of the retina re-detached during the postoperative follow-up period (4.4 months on average). The best corrected visual acuity (BCVA) on the final follow-up day was superior to the preoperative BCVA in all 7 of the eyes. The BCVA improved by more than of 0.3 with logMAR in 4 of 7 eyes.
The results of this study suggest that the ILM flap technique can be effectively applied to the treatment of macular hole with retinal detachment in high myopia combined with posterior staphyloma and that the hole closure results in improved postoperative BCVA.
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