Multiple Free Internal Limiting Membrane Flap Insertion in the Treatment of Macular Hole-Associated Retinal Detachment in High Myopia

Abstract

Purpose: The aim of this paper was to evaluate the efficacy of multiple free internal limiting membrane (ILM) flap insertion in the management of macular hole-associated retinal detachment in high myopia. Procedures: Eyes receiving operation for macular hole-associated retinal detachment were retrospectively recruited. Those in the study group received ILM peeling and multiple free ILM flap insertion, while those in the control group received ILM peeling only. Postoperative anatomical outcomes and best-corrected visual acuity were compared between the 2 groups. Results: Twenty-seven eyes of 27 patients were recruited in this study (13 in the study group, 14 in the control group). After the operation, the retina was reattached in all cases in both groups. The macular hole closure rate was 100% in the study group but only 42.9% in the control group (adjusted p < 0.001). The eyes in the study group had better visual improvement (logMAR –0.58 ± 0.43) than those in the control group (logMAR –0.31 ± 0.50) with borderline significance (adjusted p = 0.078). Conclusions: For macular hole-associated retinal detachment in highly myopic eyes, the multiple free ILM flap insertion technique offers an effective way to close macular holes. Whether this result also means better visual outcome remains to be seen.

A human Amniotic Membrane plug to manage high myopic macular hole associated with retinal detachment

“…Many techniques have been proposed to increase closure rate in recurrent HMMH with RD, such as autologous blood (Lai et al 2015), ILM free patch (Morizane et al 2014;Dai et al 2016;Chen et al 2018) and retinal autograft (Grewal & Mahmoud 2016;Wu et al 2018). The purpose behind these techniques was to find a substrate to seal the MH in order to prevent fluid passing through the MH to the subretinal space, and to allow tissue proliferation in order to obtain retinal restoration and VA recovery.…”

Internal Limiting Membrane Flaps for Coexistent Macular Hole and Retinal Detachment in Eyes with Proliferative Diabetic Retinopathy

“…If the size of the ILM flaps was judged inadequate, the double ILM insertion technique was used [ 6 ], done by adding a piece of previously obtained free ILM flap on top of the inverted ILM tissue until it was securely in place. If, however, the ILM flaps around the hole edge were difficult to create, or ILM tissue adjacent to the hole had been torn away inadvertently or along with ERM, 2 to 3 pieces of free ILM flap were inserted sequentially into the hole instead after copious Viscoat® agent was injected in and around the MH [ 7 ]. Fluid-air exchange (FAX) up to the detached margin was performed for localized RD within the arcade.…”

“…Conventional surgery with vitrectomy and complete internal limiting membrane (ILM) peeling results in an unsatisfactory macular closure rate [ 1 ]. Recently, several surgical techniques have been developed, including the use of epiretinal ILM flap covering the hole [ 2 , 3 ]; ILM flap insertion into the hole, with or without the adjunct of blood clot and viscoelastic agents [ 4 – 6 ]; or even free ILM flaps [ 7 ]. High MH closure rates can be achieved.…”

Sub-perfluoro-n-octane injection of ocular viscoelastic device assisted inverted internal limiting membrane flap for macular hole retinal detachment surgery: a novel technique

“…This fluid, combined with the movement of the globe, could produce turbulence, which may dislocate the ILM flap from the MH after surgery. Thus, retinal glue such as OVD to stabilize the ILM flap has been used to resolve the problem [5,7,11,12]. However, OVD application onto MH or ILM is challenging in a fluid-filled eye.…”

“…The ideal modality for treating MHRD remains unknown. Recently, MHRD surgical intervention by pars plana vitrectomy (PPV) with an inverted internal limiting membrane (ILM) flap [2] and its modified techniques have been developed to improve retinal attachment and macular hole (MH) closure rate [3][4][5][6].…”