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Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes
Author(s) -
Ho TzyyChang,
Ho Allen,
Chen MuhShy
Publication year - 2018
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13514
Subject(s) - vitrectomy , macular hole , ophthalmology , fundus (uterus) , internal limiting membrane , retinal detachment , medicine , retinal , visual acuity , foveolar cell , optometry , surgery , stomach , gastroenterology , gastric mucosa
Purpose We investigated the surgical results of macular hole retinal detachment ( MHRD ) with a modified C‐shaped temporal inverted internal limiting membrane ( ILM ) flap to reconstruct the foveolar architecture in highly myopic eyes. Methods Eighteen highly myopic eyes with MHRD in 17 patients who underwent a vitrectomy with a modified C‐shaped temporal inverted ILM flap were followed for 12 months. Anatomic outcomes were evaluated by fundus examinations and optical coherence tomography. The preoperative and postoperative best‐corrected visual acuities ( BCVA s) were compared as functional outcomes. Results Women accounted for 88% of the MHRD patients. The mean age was 60.2 ± 8.2 years. The mean axial length was 29.25 ± 2.10 mm. Type 1 and type 2 MHRD was present in four eyes and 14 eyes, respectively. After a single surgery, the hole was closed in 18 eyes (100%). Retinal attachment was achieved in 95%. Persistent shallow subretinal fluid (SRF) was noted in one case, which was resolved at follow‐up. The surgery significantly improved BCVA s (from 1.7 ± 0.6 to 0.72 ± 0.4 logarithm of the minimum angle of resolution units [p < 0.001]) at the last visit. In total, 94.4% of the eyes had restored foveolar architecture. Ellipsoid zone recovery within the foveola was found in 77.8% of the eyes. Conclusion A vitrectomy and modified C‐shaped inverted temporal ILM flap is effective for closing MH s, reattaching the retina, restoring the foveolar architecture and significantly improving the postoperative BCVA in MHRD patients. This technique is feasible, and we propose ‘presumed’ Müller cell cone repair in MHRD surgery.