Inverted Internal Limiting Membrane Flap Coverage with Autologous Blood Technique after Air-fluid Exchange and Silicone Oil Tamponade for Extensive Macular Hole Retinal Detachment in Highly Myopic Eyes.

PURPOSE: To report a technique consisting of inverted internal limiting membrane (ILM) flap coverage with autologous blood after air-fluid exchange and silicone oil tamponade in treating extensive retinal detachment (RD) secondary to a myopic macular hole (MH).

METHODS: Retrospective case series. The technique was applied in 18 eyes with MH-RD extending beyond the equator with a minimum follow-up of 6 months. The procedures for pars plan vitrectomy (PPV) included the following:1) the ILM was peeled to the superior and inferior arcade margins, and except for the ILM in the temporal region, was hinged toward the edge of the MH. 2) Air-fluid exchange was then performed to drain the subretinal fluid (SRF) through the MH with a flute needle, ensuring that a small amount of SRF remained to facilitate ILM flap inversion. 3) The ILM flap was used to cover the MH with the assistance of autologous blood.

RESULTS: Six months after surgery, the MH was successfully anatomically closed, and retinal reattachment was observed in all 18 eyes of 18 patients. The mean best-corrected visual acuity (BCVA, logMAR) improved from 2.03 ± 0.61 (ranging from hand motion [HM] [2.6] to finger counting [FC] [2.3]) to 1.23 ± 0.63 (ranging from HM [2.6] to 20/28 [0.15]) (P < 0.01) at 6 months.

CONCLUSION: This surgical technique using an inverted ILM flap combined with autologous blood provides an option for the treatment of extensive MHRD.