Double Internal Limiting Membrane Insertion for Macular Hole-Associated Retinal Detachment

San-Ni Chen, Chung-May Yang, San-Ni Chen, Chung-May Yang

Abstract

Purpose: To describe a modified technique of internal limiting membrane (ILM) insertion for macular hole- (MH-) associated retinal detachment (RD) in highly myopic eyes.

Methods: Nine eyes underwent pars plana vitrectomy, cortical vitreous removal, and fovea-sparing ILM peeling. Double ILM insertion into the hole was performed with inverted perifoveal ILM and a free ILM flap followed by air-fluid exchange.

Results: Two of the 9 eyes had perifoveal ILM partially torn after cortical vitreous or epiretinal removal. All eyes had the ILM plug stabilized within the MH after double ILM insertion. Postoperatively, MH was sealed with the retina reattached in all the eyes.

Conclusion: Double ILM insertion may further secure the ILM flap in place in the eyes with MH-associated RD, especially in cases in which insufficient perifoveal ILM was left. This trial is registered with the clinical registration number Clinicaltrials.gov NCT03174639.

Figures

Figure 1
Figure 1
Direct forceps grasping was used to create an ILM break where a good ICG staining had been obtained (a). A ring-shaped ILM flap was created around the macular hole (b). The ILM was detached from the retina to the edge of the macular hole (c). Further anterior ILM peeling was performed up to the arcade along with the overlying ERM. The ILM flap anchoring on the hole edge was inverted and inserted into the hole using microforceps (d). A small amount of Viscoat was then carefully applied on top of the hole. After the infusion was turned off, a piece of the previously obtained free ILM flap was released from the microforceps on top of the macular hole (e). The microforceps with closed tips was used to guide the ILM tissue to fall on the hole and to nudge the free ILM tissue into the hole (f).
Figure 2
Figure 2
A 62-year-old woman developed a macular hole with retinal detachment in the left eye. Preoperative fundus photograph and optical coherence tomographic image showed the macular hole with localized posterior retinal detachment and adherent epiretinal membrane (a, b). Fundus photograph and optical coherence tomographic images 2 months after surgery showed the sealed macular hole with shallow residual subretinal fluid (c, d).

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Source: PubMed

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