INVERTED INTERNAL LIMITING MEMBRANE FLAP PLUS FOVEA-SPARING PEELING AND REPOSITIONING: A NOVEL APPROACH FOR MYOPIC TRACTION MACULOPATHY.

PURPOSE: To examine the efficacy and safety of IPS procedure-comprising an i nverted internal limiting membrane (ILM) flap, fovea-sparing peeling, and repositioning assisted by the subperfluoro-n-octane injection of an ophthalmic viscoelastic device-in eyes with myopic traction maculopathy (MTM) and a high risk of postoperative full-thickness macular hole (FTMH) formation.

METHODS

This retrospective, consecutive, and interventional case series included eight MTM cases with lamellar macular hole and foveal detachment (FD). All patients underwent vitrectomy with IPS procedure and gas tamponade, with a minimum follow-up of 6 months.

RESULTS

Between April and November 2024, eight consecutive eyes underwent IPS, with a median follow-up of 414 days. The cohort included two men (25%) and six women (75%), with a mean age of 62 years and a mean axial length of 29.83 mm. Mean VA improved from 0.54 to 0.23 logMAR (Snellen equivalent, 20/70 to 20/35), and mean central foveal thickness decreased from 571.6 μm to 279.5 μm. No eyes developed postoperative FTMH. Retinoschisis was completely resolved in five eyes (62.5%), and FD was reversed in five out of six eyes (83.3%). Inner retinal dimples were noted in four eyes (50.0%) and were confined to areas exposed by the inverted ILM flap, with no inner retinal dimples in the ILM-repositioning area.

CONCLUSION

IPS relieves traction, restores ILM integrity, minimizes inner retinal surgical trauma, and protects an ultrathin fovea, thereby reducing the risk of postvitrectomy FTMH and achieving functional and morphologic improvements in patients with MTM at high risk for postoperative FTMH.