Perfluorocarbon Liquid–assisted Inverted Internal Limiting Membrane Flap Technique Versus Internal Limiting Membrane Peeling for Highly Myopic Macular Hole Retinal Detachment

Abstract

Purpose: To compare the efficacy of a modified perfluorocarbon liquid–assisted inverted internal limiting membrane (ILM) flap technique with the standard ILM peeling for the treatment of macular hole retinal detachment in highly myopic eyes. Methods: This was a retrospective, consecutive, nonrandomized comparative study. Forty-two macular hole retinal detachment eyes of 42 patients were included into either a perfluorocarbon liquid–assisted inverted ILM flap technique group (n = 22, inverted group) or standard ILM removal group (n = 20, peeling group). Outcomes measured were macular hole closure, retinal reattachment, and best-corrected visual acuity at least 6 months after surgery. Results: Macular hole closure was achieved in 20 eyes (90.9%) in the inverted group and in eight eyes (40%) in the peeling group (P < 0.01). Reattachment rates were 100% in the inverted group and 95% in the peeling group (P = 0.476). The mean best-corrected visual acuity improvement from baseline was 27.4 ± 19.9 Early Treatment Diabetic Retinopathy Study letters in the inverted group while the best-corrected visual acuity improvement was 13.6 ± 22.5 Early Treatment Diabetic Retinopathy Study letters in the peeling group (P = 0.044). Conclusion: The perfluorocarbon liquid–assisted inverted ILM flap technique was effective in sealing the macular hole, reattaching retina, and improving visual function postoperatively in highly myopic macular hole retinal detachment.

The Role of Internal Limiting Membrane Flap for Highly Myopic Macular Hole Retinal Detachment: Improving the Closure Rate but Leading to Excessive Gliosis

“…The ILM peeling technique effectively reattached the retina but failed to achieve a satisfactory MH closure rate ( 7 – 12 ). Instead, the inverted ILM flap technique reached favorable anatomic results ( 8 , 11 – 13 ). However, previous studies of the effect of these two techniques on the postoperative BCVA have shown inconsistent results.…”

“…Although the retinal reattachment rate is high after the conventional pars plana vitrectomy (PPV) technique with membrane complex removal, the MH closure rate has been unsatisfactory, ranging from 25 to 86% ( 7 – 12 ). After introducing the inverted ILM flap technique, better anatomical success was achieved in recent years ( 8 , 11 – 13 ). Previous studies have demonstrated that the inverted flap technique assisted by perfluorocarbon liquid (PFCL) can achieve a better functional and anatomical prognosis ( 8 , 14 ).…”

“…After introducing the inverted ILM flap technique, better anatomical success was achieved in recent years ( 8 , 11 – 13 ). Previous studies have demonstrated that the inverted flap technique assisted by perfluorocarbon liquid (PFCL) can achieve a better functional and anatomical prognosis ( 8 , 14 ). Besides PFCL, autologous blood (AB) containing rich growth factors has been applied in MHRD surgery to facilitate MH closure ( 15 ).…”

Inverted Internal Limiting Membrane Flap Technique: Is It the Best Option for Macular Holes?

“… 85 The use of perfluorocarbon liquid in FTMHs with RD and viscoat ® in FTMHs without RD combined with inverted ILM flap technique were proposed to increase the success rate of the surgery. 86 , 87 …”

“…85 The use of perfluorocarbon liquid in FTMHs with RD and viscoat ® in FTMHs without RD combined with inverted ILM flap technique were proposed to increase the success rate of the surgery. 86,87 Comparing with idiopathic FTMHs, traumatic FTMHs have a higher likelihood of spontaneous closure (up to 67%) that often occurs within 3 months after ocular trauma. 88 There was a trend toward small size in spontaneously closed traumatic FTMHs.…”