Efficacy of the Semicircular Inverted Internal Limiting Membrane Flap Technique for Macular Hole Retinal Detachment in Hyperopic Eyes: A Case Series

TL;DR

This case series shows that a specific surgical technique can effectively treat retinal detachment in hyperopic eyes with macular holes.

Contribution

The study introduces the use of a semicircular inverted ILM flap for hyperopic macular hole retinal detachment.

Findings

All three patients achieved immediate macular hole closure and retinal reattachment after 18-24 months.

Visual acuity improved in two patients, with OCT showing foveal restoration and ELM/EZ integrity.

No intraoperative complications or recurrence were observed, supporting the technique's feasibility and reliability.

Abstract

We report anatomical and functional outcomes for three hyperopic phakic women with macular hole retinal detachment (MHRD) treated using a superiorly based semicircular inverted internal limiting membrane (ILM) flap. All patients underwent 25-gauge pars plana vitrectomy with Brilliant Blue G-assisted ILM manipulation, inversion of a superior semicircular flap to cover the macular hole, and 20% sulfur hexafluoride (SF₆) tamponade. Postoperative assessment included decimal best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (OCT). All eyes achieved immediate macular hole closure, and complete retinal reattachment was attained after 18-24 months. Final BCVA improved in two eyes (from 0.1 to 0.4) and remained 0.2 in one eye, underscoring delayed but meaningful recovery in hyperopic MHRD treated with a semicircular inverted ILM flap. OCT demonstrated stepwise foveal restoration with variable ellipsoid zone/external limiting membrane (ELM/EZ) integrity across cases, and no intraoperative complications, macular hole reopening, or recurrent detachment were observed. These findings indicate that in hyperopic MHRD, a semicircular inverted ILM flap is feasible and mechanically reliable for early hole closure, while SRF absorption and functional recovery may require prolonged follow-up, likely reflecting the timeline of outer-retinal reconstruction.

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