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Highly Myopic Macular Hole Surgery by the Internal Limiting Membrane Flap with No Gas Tamponade Technique: A
Simon K H Szeto1, Amy H Y Yu1, Vivian W K Hui1
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital, Hong Kong SAR, China.
Purpose:
To report the surgical outcomes of the internal limiting membrane (ILM) flap with no gas tamponade technique in managing high myopia-associated macular hole (MH).
Design:
Prospective interventional case series.
Participants:
Patients with high myopia-associated full-thickness MH.
Methods:
Consecutive patients with high myopia-associated MH were prospectively recruited. High myopia was defined as refraction of spherical equivalence of ≤-6.0 diopters (in phakic eyes) or axial length (AL) ≥26 mm. The ILM flap without gas tamponade technique was used for MH repair; conversion to conventional surgery with gas tamponade was the contingency surgical plan when necessary.
Main Outcomes Measures:
Primary outcome was the MH closure rate at week 12. Key secondary outcomes included postoperative best-corrected visual acuity (BCVA) and time to MH closure.
Results:
Twenty eyes from 20 patients were included. The mean age was 67.2 years, and the median duration of symptoms was 9.5 months. The mean ± standard deviation baseline logarithm of the minimum angle of resolution BCVA was 0.77 ± 0.39, the mean AL was 28.9 ± 2.20 mm, and the mean minimum linear diameter was 424.0 ± 197.7 μm. All participants underwent the planned study intervention and completed the week 12 visit for the assessment of the primary outcome. Macular hole closure was achieved in 20 (100%) eyes at week 12, and the median time to MH closure was 1 week (range, 0-12 weeks). The postoperative mean logarithm of the minimum angle of resolution BCVA was 0.75 ± 0.29 (P = 0.832), 0.50 ± 0.25 (P = 0.013), 0.36 ± 0.21 (P < 0.001), 0.30 ± 0.21 (P < 0.001), and 0.25 ± 0.23 (P < 0.001) at postoperative day 1 and weeks 1, 4, 12, and 24, respectively. The number of eyes with BCVA ≥20/50 increased from 6 (30%) on day 1 to 12 (60%), 17 (85%), 18 (90%), and 18 (94.7%) at weeks 1, 4, 12, and 24, respectively.
Conclusions:
The ILM flap with no gas tamponade technique is effective in repairing high myopia-associated MH, achieving a high closure rate and quick postoperative visual recovery. Results from this study support the need for a collaborative multicenter randomized controlled trial.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
