Abstract
Purpose :
Macular hole retinal detachment (MHRD) is a challenging disease for vitreoretinal surgeons. Because of the dysfunctional drainage of the retinal pigment epithelial (RPE) cells in highly myopic eyes, it is important to completely drainage the subretinal fluid through MH during surgery.
Methods :
The step-by-step procedure of perfluorocarbon liquid (PFCL)-assisted internal limiting membrane (ILM) flap technique is shown in Figure 1. The nasal, superior, and inferior ILM is peeled off circumnavigating the MH while the remaining one-quarter ILM in the temporal part is half peeled. Air-fluid exchange is then performed to drainage the subretinal fluid through the macular hole as completely as possible to reattach the retina. PFCL is gently introduced over the macula and ensure the remaining ILM is under the PFCL. The ILM forceps is used to re-grasp the advancing edge of the remaining ILM and invert the ILM to cover the MH. The remant fluid and PFCL is then removed. Silicon oil is finally filled and patient is suggested a facedown position for one week. OCT was performed and best corrected visual acuity (BCVA) was examined at each postoperative follow-up.
Results :
We have successfully performed this technique in 10 consecutive eyes in 10 patients. The average axial length was 29.28 ± 2.01 mm. Nine eyes had extensive retinal detachment extended to or beyond the equator. All cases achieved initial retinal reattachment and macular hole closure on SD-OCT the next day. Free ILM flap covering the macular hole was also confirmed using SD-OCT. BCVA was improved in 8 eyes (80%, stable in2 eyes (20%) after an average 4.5 ± 1.2 follow-up months.
Conclusions :
The PFCL-assisted ILM flap technique we reported can achieve favorable MH closure and retinal reattachment with good visual outcome for MHRD in highly myopic eyes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.