Novel Technique for Macular Hole-Associated Retinal Detachment With the Inverted Internal Limiting Membrane Flap Technique Under Perfluorocarbon Liquid.

Abstract

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. This retrospective study was approved by the Ethics Committee of Akita University Hospital. Eight patients with macular hole-associated retinal detachment underwent pars plana vitrectomy 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 1 day. All eight patients achieved initial retinal reattachment and macular hole closure without intraoperative or postoperative complications. After 12 months of follow-up, macular hole closure and retinal reattachment were maintained in all cases. This novel technique avoids iatrogenic breaks, reducing epiretinal membrane 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 macular hole-associated retinal detachment treatment in this small series.