Long-term surgical outcomes of the inverted internal limiting membrane flap technique in highly myopic macular hole retinal detachment
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Pars plana vitrectomy (PPV) procedures are used for the surgical treatment of macular hole retinal detachment (MHRD) associated with high myopia. Re-detachment of the retina has been reported in MHRD associated with high myopia. Our aim was to evaluate the 1-year outcomes of vitrectomy, performed using an inverted internal limiting membrane (ILM) flap technique with gas tamponade, in five cases of MHRD associated with high myopia.
We performed a retrospective review of medical records of five consecutive cases of highly myopic MHRD. The following postoperative data were collected: refractive error, best-corrected visual acuity, intraocular pressure, ophthalmic fundus examination findings, ocular coherence tomography at 1, 3, 6, and 12 months postoperatively; duration of the follow-up period; and intra- and postoperative complications. The primary endpoint of the study was the rate of postoperative retinal reattachment and macular hole (MH) closure. Paired t-tests were conducted to evaluate postoperative changes.
Mean visual acuity improved significantly (P = 0.008), with an improvement of ≥2 lines on LogMAR value gained in three of the five eyes. Retinal reattachment was maintained in all cases, with no cases of MH reopening identified over the mean follow-up period of 20.2 months. No complications were identified in any eye.
The inverted ILM flap technique and gas tamponade provided primary retinal reattachment and MH closure over the ≥12-month follow-up period.
KeywordsInverted internal limiting membrane flap technique Highly myopic macular hole retinal detachment
This research was not support by funding from the public, commercial, or not-for-profit sectors. The authors have no financial disclosures to report.
Compliance with ethical standards
For this type of study formal consent is not required.
No funding was received for this research.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
This intraoperative OCT video was recorded after fluid-air exchange without draining the SRF through the MH. In this video, the posterior retina appeared dome shaped, over the submacular fluid, with the ILM covering the MH. (MP4 6060 kb)
- 5.Ichibe M, Yoshizawa T, Murakami K, Ohta M, Oya Y, Yamamoto S, Funaki S, Funaki H, Ozawa Y, Baba E, Abe H (2003) Surgical management of retinal detachment associated with myopic macular hole: anatomic and functional status of the macula. Am J Ophthalmol 136:277–284. doi: 10.1016/S0002-9394(03)00186-7 CrossRefPubMedGoogle Scholar
- 7.Ando F, Ohba N, Touura K, Hirose H (2007) Anatomical and visual outcomes after episcleral macular buckling compared with those after pars plana vitrectomy for retinal detachment caused by macular hole in highly myopic eyes. Retina 27:37–44. doi: 10.1097/01.iae.0000256660.48993.9e CrossRefPubMedGoogle Scholar
- 9.Nakanishi H, Kuriyama S, Saito I, Okada M, Kita M, Kurimoto Y, Kimura H, Takagi H, Yoshimura N (2008) Prognostic factor analysis in pars plana vitrectomy for retinal detachment attributable to macular hole in high myopia: a multicenter study. Am J Ophthalmol 146:198–204. doi: 10.1016/j.ajo.2008.04.022 CrossRefPubMedGoogle Scholar
- 10.Alkabes M, Bures-Jelstrup A, Salinas C, Medeiros MD, Rios J, Corcostegui B, Mateo C (2014) Macular buckling for previously untreated and recurrent retinal detachment due to high myopic macular hole: a 12-month comparative study. Graefes Arch Clin Exp Ophthalmol 252:571–581. doi: 10.1007/s00417-013-2497 CrossRefPubMedGoogle Scholar
- 14.Ikuno Y, Sayanagi K, Oshima T, Gomi F, Kusaka S, Kamei M, Ohji M, Fuhikado T, Tano Y (2003) Optical coherence tomographic findings of macular holes and retinal detachment after vitrectomy in highly myopic eyes. Am J Ophthalmol 136:477–481. doi: 10.1016/S0002-9394(03)00269-1 CrossRefPubMedGoogle Scholar
- 17.Lai CC, Chen YP, Wang NK, Chuang LH, Liu L, Chen KJ, Hwang YS, Wu WC, Chen TL (2015) Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes. Ophthalmology 122:1889–1898. doi: 10.1016/j.ophtha.2015.05.040 CrossRefPubMedGoogle Scholar
- 20.Yamamoto N, Ozaki N, Murakami K (2004) Triamcinolone acetonide facilitates removal of the epiretinal membrane and separation of the residual vitreous cortex in highly myopic eyes with retinal detachment due to a macular hole. Ophthalmologica 218:248–256. doi: 10.1159/000078615 CrossRefPubMedGoogle Scholar
- 23.Okuda T, Higashide T, Kobayashi K, Ikuno Y, Sugiyama K (2016) Macular hole closure over residual subretinal fluid by an inverted internal limiting membrane flap technique in patients with macular hole retinal detachment in high myopia. Retin Cases Brief Rep 10:140–144. doi: 10.1097/ICB.0000000000000205 CrossRefPubMedGoogle Scholar