Novel technique for macular hole-associated retinal detachment with inverted internal limiting membrane flap technique under perfluorocarbon liquid.

Abstract

Purpose: To describe the technique and surgical outcomes of a modified inverted internal limiting membrane (ILM) flap technique, using perfluorocarbon liquid (PFCL) without creating iatrogenic retinal breaks in the management of macular hole-associated retinal detachment (MHRD).

Methods: This retrospective study was approved by the Ethics Committee of Akita University Hospital. Eight patients with MHRD underwent pars plana vitrectomy (PPV) with the novel PFCL-assisted inverted ILM flap technique. Subretinal fluid was drained through the macular hole using a soft-tip needle, and ILM staining was performed after fluid-air exchange. PFCL was applied to stabilize the retina, and ILM peeling was completed under PFCL with improved visibility. The procedure concluded with air-fluid exchange and tamponade using silicone oil or gas. Patients maintained a face-down position postoperatively for one day.

Results: All eight patients achieved initial retinal reattachment and macular hole closure without intraoperative or postoperative complications. After over 12 months of follow-up, macular hole closure and retinal reattachment were maintained in all cases.

Discussion: Our novel technique avoids iatrogenic breaks, reducing ERM risk and secondary macular hole formation. The PFCL-assisted ILM manipulation ensures stability and minimizes retinal damage. The method is safe, effective, and promising for MHRD treatment in this small series.