METHODS: A retrospective case series of 20 eyes with MHRD that underwent vitrectomy with internal limiting membrane (ILM) peeling and inverted flap (16 eyes, 80%), ILM insertion (3 eyes, 15%), or ILM free flap (1 eye, 5%) assisted by the SPOT technique in a tertiary referral center. The main outcomes measures were best-corrected visual acuity (BCVA) and the final hole closure and reattachment of the macula accessed by spectral-domain optical coherence tomography.
RESULTS: The mean axial length of was 28.17 ± 3.0 mm (range, 20.61-33.10 mm) and the mean follow-up time was 382 ± 214 days. After vitrectomy with SPOT technique, primary hole closure was noted in all 20 eyes. In two eyes (10%) the hole reopened but the retina remained attached. In another two eyes, minimal subretinal fluid persisted despite hole closure. The final hole closure and retinal reattachment rates were both 90% (18 eyes). At the last visit, 14 eyes (70%) had improved BCVA and the logMAR BCVA improved from 1.44 ± 0.47 (Snellen 20/550) to 1.12 ± 0.59 (Snellen 20/260). No significant difference was observed in the functional and anatomical outcomes between MHRD within the arcades (9 eyes, 45%) and beyond the arcades (11 eyes, 55%).
CONCLUSIONS: For macular holes with retinal detachment, SPOT successfully assisted different internal limiting membrane flap techniques and achieved 90% macular hole closure and 90% retinal reattachment rates. In 90% of the eyes, the vision stabilized or improved. SPOT technique has a gentle learning curve and allows surgeons to manipulate the ILM flap with ease, which is beneficial in challenging surgeries such as macular holes accompanied with a detached retina.
TRIAL REGISTRATION: Retrospectively registered.
DESIGN: Retrospective interventional case series.
METHODS: Thirty-nine eyes from 39 patients with a FTMH <600 μm were included from a single institution. All patients underwent vitrectomy using a semicircular single-layered ILM inverted flap assisted by a sub-perfluorocarbon liquid injection of ophthalmic viscoelastic device (OVD) technique. Best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography were used to compare outcomes between nasal (n = 19) and temporal (n = 20) groups.
RESULTS: At 6 months postoperatively, all FTMHs closed and BCVA were significantly improved. Overall, 36 eyes (92%) achieved U-shaped closure, and ellipsoid zone restoration was noted in 24 eyes (62%). An ILM flap was present in 29 eyes (74%) and 86% remained single-layered. There were significantly more deep inner retinal dimples in the temporal group (35%) compared with 5% in the nasal group (P = .04), but these were unrelated to BCVA. Significant retinal thinning in the temporal outer sub-field was noted in the temporal group and was negatively correlated with BCVA (rho [ρ]: - .53; P = .03). No significant postoperative retinal displacement was noted in either group.
CONCLUSIONS: The technique of using sub-perfluorocarbon liquid injection of OVD secured single-layered flaps intraoperatively and postoperatively. Both the nasal and temporal inverted ILM flaps repaired FTMH and improved visual acuity. However, both temporal macular thinning and deep inner retinal dimples were significantly greater in the temporal group.