Retinal detachment associated to macular hole in nanophthalmos and high hyperopia

We report the case of a 74-year-old woman with high hyperopia and nanophthalmos who presented with a progressive central scotoma in her left eye. Best-corrected visual acuity was limited to hand motion, and examination revealed a full-thickness macular hole associated with retinal detachment. Pars plana vitrectomy with the inverted internal limiting membrane (ILM) flap technique and 20% sulfur hexafluoride (SF6) tamponade was performed, but hole closure was not achieved. A second surgery including phacovitrectomy, retinal massage and ILM flap repositioning resulted in successful anatomical closure and visual improvement. This case highlights the value of adjunctive techniques such as retinal massage and accurate ILM flap repositioning to promote closure in complex and uncommon scenarios.