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Novel Technique for Macular Hole-Associated Retinal Detachment With the Inverted Internal Limiting Membrane Flap
Jiro Kogo, Kazuhito Yoneda1, Takeshi Iwase2
1Subarukai Eye center, Higashi-Konoe City, Shiga, Japan.
Purpose:
To describe the technique and surgical outcomes of a modified inverted internal limiting membrane (ILM) flap technique, using perfluorocarbon liquid (PFCL) without creating iatrogenic retinal breaks in the management of macular hole-associated retinal detachment.
Methods:
This retrospective study was approved by the Ethics Committee of Akita University Hospital. Eight patients with macular hole-associated retinal detachment underwent pars plana vitrectomy with the novel PFCL-assisted inverted ILM flap technique. Subretinal fluid was drained through the macular hole using a soft-tip needle, and ILM staining was performed after fluid-air exchange. PFCL was applied to stabilize the retina, and ILM peeling was completed under PFCL with improved visibility. The procedure concluded with air-fluid exchange and tamponade using silicone oil or gas. Patients maintained a face-down position postoperatively for 1 day.
Results:
All eight patients achieved initial retinal reattachment and macular hole closure without intraoperative or postoperative complications. After 12 months of follow-up, macular hole closure and retinal reattachment were maintained in all cases.
Conclusion:
This novel technique avoids iatrogenic breaks, reducing epiretinal membrane risk and secondary macular hole formation. The PFCL-assisted ILM manipulation ensures stability and minimizes retinal damage. The method is safe, effective, and promising for macular hole-associated retinal detachment treatment in this small series.
Insights
This study introduces a new perfluorocarbon liquid (PFCL)-assisted inverted internal limiting membrane (ILM) flap technique for macular hole-associated retinal detachment (MHRD). The method successfully achieved retinal reattachment and macular hole closure in all patients, avoiding complications.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Surgical Innovation
Background:
- Macular hole-associated retinal detachment (MHRD) presents significant challenges in surgical management.
- Conventional techniques may involve risks of iatrogenic retinal breaks and secondary macular hole formation.
Purpose of the Study:
- To detail a modified inverted internal limiting membrane (ILM) flap technique utilizing perfluorocarbon liquid (PFCL).
- To evaluate the surgical outcomes of this novel approach in managing MHRD without creating iatrogenic retinal breaks.
Main Methods:
- Retrospective analysis of eight patients with MHRD undergoing pars plana vitrectomy (PPV).
- Implementation of a PFCL-assisted inverted ILM flap technique, including subretinal fluid drainage via the macular hole and ILM peeling under PFCL.
- Postoperative management involved air-fluid exchange, silicone oil or gas tamponade, and a one-day face-down position.
Main Results:
- Complete initial retinal reattachment and macular hole closure were achieved in all eight patients.
- No intraoperative or postoperative complications were observed.
- Sustained retinal reattachment and macular hole closure were maintained in all cases after over 12 months of follow-up.
Conclusions:
- The PFCL-assisted inverted ILM flap technique is a safe and effective method for MHRD management.
- This novel approach successfully avoids iatrogenic retinal breaks, potentially reducing the risk of epiretinal membrane (ERM) formation and secondary macular hole development.
- The technique offers improved retinal stability and minimized retinal damage during ILM manipulation, showing promise for MHRD treatment.
