Internal Limiting Membrane Flap and Insertion Techniques Improve Prognosis in Macular Hole-Associated Retinal Detachment

Abstract

Purpose: To compare the long-term anatomic and visual outcomes of macular hole (MH)-associated retinal detachment (MHRD) treated with internal limiting membrane (ILM) peeling, ILM insertion, or inverted ILM flap techniques.

Design: Retrospective and comparative study.

Participants: Two hundred eighty-eight patients with MHRD who underwent pars plana vitrectomy and ILM technique were enrolled at the Eye and ENT Hospital of Fudan University.

Methods: Two hundred ninety-five eyes were divided into ILM peeling (138 eyes), ILM insertion (54 eyes), and ILM flap (103 eyes) groups and subdivided according to the extent of retinal detachment, non-high/high myopia, proliferative vitreoretinopathy (PVR) grade, and chorioretinal atrophy (CA) grade. The initial retinal reattachment rate, MH closure rate, postoperative best-corrected visual acuity (BCVA), and improvement in BCVA were evaluated.

Main outcome measures: Anatomic and visual outcomes of MHRD treated with ILM peeling, insertion, or flap techniques.

Results: The ILM flap and insertion techniques were associated with significantly better initial MH closure rate than ILM peeling (91% vs 87% vs 54%, P < 0.001) along with a greater BCVA improvement (P < 0.001). The proportion of eyes with BCVA improvement was higher for the ILM flap technique than for ILM insertion (96% vs 83%, P < 0.005). In eyes with non-high myopia (axial length <26 mm), the ILM flap technique demonstrated better postoperative BCVA improvement than ILM peeling, but without an anatomic advantage. In eyes with PVR grade C or CA grade 4, the ILM flap technique achieved greater MH closure rates than ILM peeling, but without visual benefits. Retinal detachment extending beyond the arcade, the ILM insertion, and ILM flap techniques were significantly associated with MH closure (P = 0.011, 0.001, and P < 0.001, respectively). Preoperative BCVA, retinal detachment beyond the arcade, CA grade, ILM insertion technique, and ILM flap technique were independently associated with the BCVA improvement (P = 0.003, 0.009, 0.006, and 0.014 and P < 0.001, respectively).

Conclusions: The ILM insertion and flap techniques were associated with greater MH closure rates and BCVA improvements compared with the ILM peeling technique for the treatment of MHRD. The ILM flap technique outperformed the ILM insertion technique in terms of functional recovery.

Financial disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Keywords: Best-corrected visual acuity; Internal limiting membrane techniques; Macular hole closure; Macular hole-associated retinal detachment.