A changeable flap: clinical observation of macular reconstruction after implementation of autologous neurosensory retinal free flap technique(ANRFFT).

Abstract

Purpose : To observethe anatomical and functional reconstruction of the macular, especially for positional and morphological changes of the flap，after implementation of ANRFFT for recurrent macular hole retinal detachment (MHRD) in patients with highly myopic eyes.

Methods : 10 eyes with recurrent MHRD in patients with highly myopia were retrospectively reviewed. All eyes had undergone PPV with ANRFFT. The main outcome measures contain the macular hole closure and retinal reattachment rate, the thickness and sensitivity threshold of the flap, the blood flow signal and position change of the flap, the sensitivity threshold and fixation ability of macula area, best corrected visual acuity (BCVA).

Results : At the last follow-up, “Closed MH” were in 7 eyes (70%). The retina reattached in 8 eyes (88.9%) after the silicone oil extraction surgery. “No shift” of the flap appeared in 7 eyes (70%). The mean flap thickness at 1 month was 220.86±31.57μm, and it decreased significantly to 175.71±23.56μm at 6 months after surgery(P=0.005, paired t-test ). The mean macular sensitivity threshold at 6 months (11.04±3.02 dB) was significantly higher than 1 month (6.28±2.23dB) (P=0.000, paired t-test ). There was no blood flow signal either superficial or deep retina layer of the flap. The post-BCVA (mean,1.32±0.31 log MAR ) had a significant improvement compared with pre-BCVA(mean,2.06±0.33log MAR) (P＜0.05 , paired t-test).

Conclusions : ANRFFT appeared safe and effective in facilitating macular hole closure and retinal reattachment, thus achieved the visual improvements in highly myopic eyes with recurrent MHRD, In the course of macular reconstruction, the flap shifts slightly and thins gradually.The study also suggested the flap adhere and fuse to the neurosensory retinal layer besides coupling of pigment epithelium which maybe is the mechanism of MH closure and retinal reattachment.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Fig 1. OCT image.A. Preoperative . B-E postoperative 1w,1 , 3 ,6m. F.“partially closed MH”.G. the flap in MHRD recurrent patient.
OCTA image (H,I). J. mean BCVAchanges after ANRFFT. *p＜0.05; **p＜0.01

 

Fig 2.OCT macular thickness map, sensitivity threshold and paracentral fixation of ANRFF technique patient. At postoperative 1 week(A/E), 1 (B/F), 3 (C/G), and 6 months(D/H),
The mean thickness of the flap.(I)
The mean sensitivity threshold.(J)
*p＜0.05; **p＜0.01.