A combination of pars plana vitrectomy, inverted internal limiting membrane flap technique and intraocular gas tamponade for macular hole–induced retinal detachment

Abstract

Purpose: To evaluate the outcome of a combination of pars plana vitrectomy (PPV), inverted internal limiting membrane (ILM) flap technique and intraocular gas tamponade for macular hole–induced retinal detachment (MHRD).

Methods: Medical records of 3 men and 12 women aged 39 to 83 years who underwent PPV with inverted ILM flap technique and intraocular gas tamponade for MHRD by a single vitreoretinal surgeon were retrospectively reviewed. Outcome was evaluated with fundus examination and spectral domain optical coherence tomography. Primary outcome measures were retinal reattachment rate, macular hole closure rate and improvement in best-corrected visual acuity (BCVA). Secondary outcome measures included subjective improvement in central scotoma or metamorphopsia. The Kaplan-Meier survival curve was analyzed with non-closure of the macular hole as the end point.

Results: The retinal reattachment rate was 100%. The rate of macular hole closure was 73.3%. The mean ± SD BCVA improved from 1.73 ± 0.69 to 1.16± 0.51 logMAR (p < 0.05). All eyes had subjective improvement in scotoma and metamorphopsia. The survival rate was 86.7% at 6 months, 74.3% at 12 months, and 74.3% at 16 months. The median survival time was 18 months. No re-opening of closed macular hole or retinal re-detachment was detected. No complications such as retinal tear, retinal detachment elsewhere, persistently elevated intraocular pressure, or endophthalmitis occurred.

Conclusion: A combination of PPV, inverted ILM flap technique and intraocular gas tamponade is an effective surgical option for MHRD.