Therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane flap covering technique for rhegmatogenous retinal detachment complicated with macular hole_Chinese Journal of Ocular Fundus Diseases

Authors：

 Liu Haiyun , Zhou Yifan , Sun Xiaodong

Department of Ophthalmology, The First People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai 200080, China;

Corresponding author：

Liu Haiyun, Email: drliuhaiyun@126.com

Keywords：

Retinal perforations/surgery; Retinal detachment/surgery; Vitreoretinal surgery

DOI：

10.3760/cma.j.issn.1005-1015.2019.06.004

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Objective To observe the therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane (ILM) flap covering technique for rhegmatogenous retinal detachment (RRD) complicated with macular hole (MH).Methods A retrospective case analysis. From January 2015 to August 2019, 29 eyes of 29 patients with RRD and MH diagnosed in the First People's Hospital Affiliated to Shanghai Jiaotong University were included in this study. There were 16 males (16 eyes) and 13 females (13 eyes). All the eyes were peripheral RRD and involving the macular area, while complicated with MH and proliferative vitreoretinopathy in stage less than C. All the eyes were examined by BCVA and OCT. The BCVA examination was performed using the Snellen visual acuity chart, which was converted into logMAR visual acuity. Before 2017, 18 eyes were treated with vitrectomy combined with ILM peeling (ILM peeling group); after 2017, 11 eyes were treated with vitrectomy combined with single-layer inverted ILM flap covering technique (ILM inverted group). The differences of age (t=0.360), onset time (t=1.235), number of holes except MH (t=0.060), RRD range (t=1.232), gas filled eyes (χ²=0.324) between the two groups were not statistically significant (P＞0.05). The average follow-up time after surgery was 4.5 months. The BCVA, retinal reattachment and MH closure at the last follow-up in the two groups were comparatively observed. U-shaped or V-shaped retina was defined as MH closure.Results At the last follow-up, retinal reattachments were achieved in all the eyes. In ILM peeling group, 5 eyes (27.8%, 5/18) were completely closed in typeⅠ. In ILM inverted group, 9 eyes (81.8%, 9/11) were completely closed in typeⅠ. There was a statistically significant difference of closure rate in type Ⅰ closure between the two groups (χ²=5.968, P=0.015). The mean logMAR BCVA in ILM peeling group and ILM inverted group were 1.24±0.28 and 0.97±0.39, respectively. The difference of logMAR BCVA between the two groups was statistically significant (t=2.179, P=0.038).Conclusion Vitrectomy combined with single-layer inverted ILM flap covering technique can increase the BCVA and MH closure rates in RRD patients with MH.

Citation： Liu Haiyun, Zhou Yifan, Sun Xiaodong. Therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane flap covering technique for rhegmatogenous retinal detachment complicated with macular hole. Chinese Journal of Ocular Fundus Diseases, 2019, 35(6): 539-543. doi: 10.3760/cma.j.issn.1005-1015.2019.06.004 Copy

1.	Najafi M, Brown JS, Rosenberg KI. Increased reoperation rate in surgical treatment of rhegmatogenous retinal detachment with coexistent macular hole[J]. Ophthalmol Retina, 2018, 2(3): 187-191. DOI: 10.1016/j.oret.2017.07.005.
2.	Mennel S, Kicova N, Callizo J. Scleral buckling in rhegmatogenous retinal detachment with concomitant full-thickness macular hole[J]. Acta Ophthalmol, 2012, 90(6): 590-591. DOI: 10.1111/j.1755-3768.2010.02002.x.
3.	O'Driscoll AM, Goble RR, Kirkby GR. Vitrectomy for retinal detachments with both peripheral retinal breaks and macular holes: an assessment of outcome and the status of the macular hole[J]. Retina, 2001, 21(3): 221-225. DOI: 10.1097/00006982-200106000-00004.
4.	Michalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes[J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/j.ophtha.2010.02.011.
5.	Shin MK, Park KH, Park SW, et al. Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery[J]. Retina, 2014, 34(9): 1905-1910. DOI: 10.1097/IAE.0000000000000339.
6.	Chen SN. Large semicircular inverted internal limiting membrane flap in the treatment of macular hole in high myopia[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(12): 2337-2345. DOI: 10.1007/s00417-017-3808-5.
7.	Ho TC, Ho A, Chen MS. Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes[J]. Acta Ophthalmol, 2018, 96(1): 46-53. DOI: 10.1111/aos.13514.
8.	刘海芸, 高敏, 杨名, 等. 玻璃体切割联合改良内界膜覆盖手术治疗复杂黄斑裂孔疗效观察[J]. 中华眼底病杂志, 2017, 33(4): 354-358. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.007.Liu HY, Gao M, Yang M, et al. Clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane flap covering technique for complicated macular hole[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 354-358. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.007.
9.	Tornambe PE, Poliner LS, Cohen RG. Definition of macular hole surgery end points: elevated/open, flat/open, flat/closed[J]. Retina, 1998, 18(3): 286-287. DOI: 10.1097/00006982-199803000-00021.
10.	Masahito I, Hiroyuki I, Teruhiko G, et al. Optical coherence tomography of successfully repaired idiopathic macular holes[J]. Am J Ophthalmol, 1999, 128(5): 621-627. DOI: 10.1016/s0002-9394(99)00200-7.
11.	Riordan-Eva P, Chignell AH. Full thickness macular breaks in rhegmatogenous retinal detachment with peripheral retinal breaks[J]. Br J Ophthalmol, 1992, 76(6): 346-348. DOI: 10.1136/bjo.76.6.346.
12.	Cunningham MA, Tarantola RM, Folk JC, et al. Proliferative vitreoretinopathy may be a risk factor in combined macular hole retinal detachment cases[J]. Retina, 2013, 33(3): 579-585. DOI: 10.1097/IAE.0b013e31826b0c41.
13.	Ah Kiné D, Benson SE, Inglesby DV, et al. The results of surgery on macular holes associated with rhegmatogenous retinal detachment[J]. Retina, 2002, 22(4): 429-434. DOI: 10.1097/00006982-200208000-00006.
14.	Singh AJ. Combined or sequential surgery for management of rhegmatogenous retinal detachment with macular holes[J]. Retina, 2009, 29(8): 1106-1110. DOI: 10.1097/IAE.0b013e3181a3b8fc.
15.	Ryan EH Jr, Bramante CT, Mittra RA, et al. Management of rhegmatogenous retinal detachment with coexistent macular hole in the era of internal limiting membrane peeling[J]. Am J Ophthalmol, 2011, 152(5): 815-819. DOI: 10.1016/j.ajo.2011.04.026.

1. Najafi M, Brown JS, Rosenberg KI. Increased reoperation rate in surgical treatment of rhegmatogenous retinal detachment with coexistent macular hole[J]. Ophthalmol Retina, 2018, 2(3): 187-191. DOI: 10.1016/j.oret.2017.07.005.
2. Mennel S, Kicova N, Callizo J. Scleral buckling in rhegmatogenous retinal detachment with concomitant full-thickness macular hole[J]. Acta Ophthalmol, 2012, 90(6): 590-591. DOI: 10.1111/j.1755-3768.2010.02002.x.
3. O'Driscoll AM, Goble RR, Kirkby GR. Vitrectomy for retinal detachments with both peripheral retinal breaks and macular holes: an assessment of outcome and the status of the macular hole[J]. Retina, 2001, 21(3): 221-225. DOI: 10.1097/00006982-200106000-00004.
4. Michalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes[J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/j.ophtha.2010.02.011.
5. Shin MK, Park KH, Park SW, et al. Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery[J]. Retina, 2014, 34(9): 1905-1910. DOI: 10.1097/IAE.0000000000000339.
6. Chen SN. Large semicircular inverted internal limiting membrane flap in the treatment of macular hole in high myopia[J]. Graefe’s Arch Clin Exp Ophthalmol, 2017, 255(12): 2337-2345. DOI: 10.1007/s00417-017-3808-5.
7. Ho TC, Ho A, Chen MS. Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes[J]. Acta Ophthalmol, 2018, 96(1): 46-53. DOI: 10.1111/aos.13514.
8. 刘海芸, 高敏, 杨名, 等. 玻璃体切割联合改良内界膜覆盖手术治疗复杂黄斑裂孔疗效观察[J]. 中华眼底病杂志, 2017, 33(4): 354-358. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.007.Liu HY, Gao M, Yang M, et al. Clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane flap covering technique for complicated macular hole[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 354-358. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.007.
9. Tornambe PE, Poliner LS, Cohen RG. Definition of macular hole surgery end points: elevated/open, flat/open, flat/closed[J]. Retina, 1998, 18(3): 286-287. DOI: 10.1097/00006982-199803000-00021.
10. Masahito I, Hiroyuki I, Teruhiko G, et al. Optical coherence tomography of successfully repaired idiopathic macular holes[J]. Am J Ophthalmol, 1999, 128(5): 621-627. DOI: 10.1016/s0002-9394(99)00200-7.
11. Riordan-Eva P, Chignell AH. Full thickness macular breaks in rhegmatogenous retinal detachment with peripheral retinal breaks[J]. Br J Ophthalmol, 1992, 76(6): 346-348. DOI: 10.1136/bjo.76.6.346.
12. Cunningham MA, Tarantola RM, Folk JC, et al. Proliferative vitreoretinopathy may be a risk factor in combined macular hole retinal detachment cases[J]. Retina, 2013, 33(3): 579-585. DOI: 10.1097/IAE.0b013e31826b0c41.
13. Ah Kiné D, Benson SE, Inglesby DV, et al. The results of surgery on macular holes associated with rhegmatogenous retinal detachment[J]. Retina, 2002, 22(4): 429-434. DOI: 10.1097/00006982-200208000-00006.
14. Singh AJ. Combined or sequential surgery for management of rhegmatogenous retinal detachment with macular holes[J]. Retina, 2009, 29(8): 1106-1110. DOI: 10.1097/IAE.0b013e3181a3b8fc.
15. Ryan EH Jr, Bramante CT, Mittra RA, et al. Management of rhegmatogenous retinal detachment with coexistent macular hole in the era of internal limiting membrane peeling[J]. Am J Ophthalmol, 2011, 152(5): 815-819. DOI: 10.1016/j.ajo.2011.04.026.

Chinese Journal of Ocular Fundus Diseases

Therapeutic effect of vitrectomy combined with single-layer inverted internal limiting membrane flap covering technique for rhegmatogenous retinal detachment complicated with macular hole

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