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Surgical techniques for the Extensive Macular Hole Detachment caused by macular holes
backdrop
Extensive retinal detachment due to macular holes is defined as a net detachment extending to or beyond the equator. It is more difficult to achieve reattachment of optic net and closure of macular hole successfully compared with reattachment limited to the posterior pole. A recent study published in RETINA reports a surgical technique that can be used for extensive retinal detachment caused by macular holes.
method
Specific surgical procedures:
1. Triamcinolone acetonide staining, complete resection of posterior vitreous body.
2. After injecting 0.3mL 0.025% indoline green into the vitreous cavity to stain ILM, remove excess dye immediately with glass cutting head.
3. Strip the upper and lower vascular arches of the inner boundary membrane around the macular hole in each quadrant, and only retain the temporal quarter of the inner boundary membrane attached to the edge of the macular hole.
4. Perform gas-liquid exchange and drain the subretinal fluid through the macular hole with a flute needle, ensuring that a very small amount of subretinal fluid is retained.
5. Use the inner boundary film pliers to re-grasp and turn the retained inner boundary film over the macular hole.
6. Take fresh blood from the patient’s anterior elbow vein, cover the macula, and form a blood clot on the surface of the macula a few minutes later.
7. Silicone oil is filled from the temporal side of the macula to avoid displacement of the inverted inner boundary membrane flap. The patient was asked to remain prone for 1 week after surgery.
result
Eighteen patients were included in this study (Table 1). Anatomical closure of the macular hole was successfully achieved 6 months after surgery, and retinal attachment was visible in 18 eyes of 18 patients. At 6 months, the logMAR of BCVA improved from 2.03±0.61 (range: manual [2.6] to index [2.3]) to 1.23±0.63 (range: manual [2.6] to 20/28 [0.15]) (P < 0.01).
Preoperative (A) and postoperative (B, D) OCT scans of patients. A. SD-OCT images of patients with macular reticulation before surgery, with a large amount of SRF in the left eye; BCVA is the index. B. One week after surgery, the macular hole was closed, the omentum was reattached, and BCVA was the index. C. One month after surgery, the neuroretina of the fovea was thickened with a BCVA of 20/200. D. 6 months after surgery, BCVA was 20/133.
Preoperative (A) and postoperative (B and D) OCT scans. A. SD-OCT images of a patient with macular reticularization before surgery, with a large amount of subretinal fluid in the left eye; BCVA is the index. B. One week after surgery, the macular hole closed, but there was still a small amount of subretinal fluid, BCVA index. C. One month after surgery, the subretinal effusion was completely absorbed with BCVA of 20/400. D. Six months after surgery, BCVA was 20/400.
discuss
In order to better observe and grasp the inner boundary membrane flap, a small amount of SRF is retained by the improved inner boundary membrane flap inversion technique proposed in this study when the gas liquid is exchanged and the subretinal fluid is discharged through the macular hole with the needle. If the subretinal fluid is completely aspirated, it may be difficult to identify the inner boundary membrane flap. In the follow-up of the cases in this study, a small amount of retained subretinal fluid was absorbed at 1 month after surgery. This study provides a new option for the treatment of extensive macular reticularization.
reference
Tao J, Zhao S, She X, Lv Z, Zhang Y. Inverted Internal Limiting Membrane Flap Coverage With Autologous Blood Technique After Air-Fluid Exchange and Silicone Oil Tamponade for Extensive Macular Hole Retinal Detachment in Highly Myopic Eyes. Retina. 2024 Jul 1; 44 (7) : 1268-1273. The doi: 10.1097 / IAE. 0000000000004068. PMID: 38502928.