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Related Experiment Video

Updated: Jun 10, 2026

An Alternative and Validated Injection Method for Accessing the Subretinal Space via a Transcleral Posterior Approach
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Subretinal Injection Using a Hinged Internal Limiting Membrane Flap Technique for Submacular Hemorrhage.

Sho Yokoyama1,2, Toshio Mori2,3, Kazuki Yoshioka2,4

  • 1Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan.

Retinal Cases & Brief Reports
|June 9, 2026
PubMed
Summary

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This study introduces a hinged internal limiting membrane (ILM) flap technique for subretinal injection in submacular hemorrhage (SMH) surgery. The technique showed no complications and a trend toward visual acuity improvement, suggesting its potential utility.

Area of Science:

  • Ophthalmology
  • Retinal Surgery
  • Vitreoretinal Interface

Background:

  • Submacular hemorrhage (SMH) poses a significant challenge in retinal surgery.
  • Maintaining retinal stability during subretinal injections is crucial for successful outcomes.
  • Existing techniques may have limitations in stabilizing the delicate retinal puncture site.

Purpose of the Study:

  • To describe a novel hinged internal limiting membrane (ILM) flap technique.
  • To evaluate the clinical outcomes and safety of this technique for submacular hemorrhage (SMH).
  • To assess the technique's efficacy in stabilizing the retinal puncture site during pars plana vitrectomy with subretinal injection.

Main Methods:

  • Retrospective case series of eight patients with SMH.
Keywords:
Hinged ILM flapRetinal punctureSubmacular hemorrhageSubretinal injectionVitrectomy

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Last Updated: Jun 10, 2026

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  • Utilized a hinged ILM flap technique for subretinal injection (balanced salt solution or tPA) followed by air injection.
  • Primary outcomes included intraoperative/postoperative complications and best-corrected visual acuity (BCVA) changes.

    • Main Results:

    • No intraoperative or postoperative complications, including retinal detachment, were observed.
    • Mean BCVA improved from 1.09 logMAR (20/250) to 0.80 logMAR (20/125), though not statistically significant (p=0.13).
    • The hinged ILM flap technique demonstrated a favorable safety profile.

    Conclusions:

    • The hinged ILM flap technique appears to be a safe and practical method.
    • It may serve as an effective adjunctive maneuver for stabilizing the retinal puncture site during subretinal injection for SMH.
    • Further research could explore its long-term efficacy and broader applications.