Application of Subretinal Balanced Salt Solution Injection: A Novel technique in treating Severe idiopathic...

To describe a novel surgical approach for treating patients diagnosed with severe idiopathic epiretinal membranes (iERM) featuring ectopic intrafoveal layers (EIFL).

A retrospective, interventional case series was conducted involving eight cases of iERM with EIFL. The technique involved a 27-gauge vitrectomy, removal of all vitreous adhesions, and injection of approximately 100μl sub-retinal balanced salt solution (BSS) using a 41-gauge subretinal needle, creating 3-4 localized bleb-like elevations around the folded retina to loosen it.

Vision improved significantly from a preoperative mean best-corrected visual acuity (BCVA) LogMAR of 0.72 (20/105) to 0.46 (20/58) at 1 week, 0.29 (20/40) (P = 0.016) at 1 month, and 0.28 (20/38) (P = 0.031) at the last follow-up. Central macular thickness (CMT) improved from a preoperative mean of 567.5 µm to 395.5 µm (P < 0.001) at 1 week, 377.38 µm (P < 0.001) at 1 month, and 381.50 µm (P < 0.001) at the last follow-up. No significant complications were observed.

The novel technique combining vitrectomy with subretinal BSS injection has demonstrated significant visual and anatomical efficacy in treating severe iERM. This approach can rapidly enhance BCVA and downgrad the EIFL Stage. Both anatomical and functional success can be achieved in this small series.