Highly Myopic Macular Hole Surgery by the Internal Limiting Membrane Flap with No Gas Tamponade Technique: A Prospective Interventional Case Series.

PURPOSE: To report the surgical outcomes of the internal limiting membrane (ILM) flap with no gas tamponade technique in managing high myopia-associated macular hole (MH).

DESIGN

Prospective interventional case series.

PARTICIPANTS

Patients with high myopia-associated full-thickness MH.

METHODS

Consecutive patients with high myopia-associated MH were prospectively recruited. High myopia was defined as refraction of spherical equivalence of ≤-6.0 diopters (in phakic eyes) or axial length (AL) ≥26 mm. The ILM flap without gas tamponade technique was used for MH repair; conversion to conventional surgery with gas tamponade was the contingency surgical plan when necessary.

MAIN OUTCOMES MEASURES: Primary outcome was the MH closure rate at week 12. Key secondary outcomes included postoperative best-corrected visual acuity (BCVA) and time to MH closure.

RESULTS

Twenty eyes from 20 patients were included. The mean age was 67.2 years, and the median duration of symptoms was 9.5 months. The mean ± standard deviation baseline logarithm of the minimum angle of resolution BCVA was 0.77 ± 0.39, the mean AL was 28.9 ± 2.20 mm, and the mean minimum linear diameter was 424.0 ± 197.7 μm. All participants underwent the planned study intervention and completed the week 12 visit for the assessment of the primary outcome. Macular hole closure was achieved in 20 (100%) eyes at week 12, and the median time to MH closure was 1 week (range, 0-12 weeks). The postoperative mean logarithm of the minimum angle of resolution BCVA was 0.75 ± 0.29 (P = 0.832), 0.50 ± 0.25 (P = 0.013), 0.36 ± 0.21 (P < 0.001), 0.30 ± 0.21 (P < 0.001), and 0.25 ± 0.23 (P < 0.001) at postoperative day 1 and weeks 1, 4, 12, and 24, respectively. The number of eyes with BCVA ≥20/50 increased from 6 (30%) on day 1 to 12 (60%), 17 (85%), 18 (90%), and 18 (94.7%) at weeks 1, 4, 12, and 24, respectively.

CONCLUSIONS

The ILM flap with no gas tamponade technique is effective in repairing high myopia-associated MH, achieving a high closure rate and quick postoperative visual recovery. Results from this study support the need for a collaborative multicenter randomized controlled trial.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.