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Updated: Jun 10, 2026
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An Alternative and Validated Injection Method for Accessing the Subretinal Space via a Transcleral Posterior Approach
Published on: December 7, 2016
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
Summary
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.
- 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.
