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Takahashi, Hiroyuki, MD; Inoue, Makoto, MD; Koto, Takashi, MD; Itoh, Yuji, MD; Hirota, Kazunari, MD; Hirakata, Akito, MD

doi: 10.1097/IAE.0000000000001898
Original Study

Purpose: To compare the efficacy of vitrectomy with inverted internal limiting membrane (ILM) flap to complete removal of the ILM for the treatment of macular hole (MH) retinal detachment in highly myopic eyes.

Methods: Pars plana vitrectomy with inverted ILM flap technique (16 eyes; inverted group) or with the complete removal of the ILM (16 eyes; removed group) was performed in patients with high myopia with MH retinal detachment. The rate of retinal reattachment and MH closure, the best-corrected visual acuities, and the integrity of the foveal microstructures in the optical coherence tomographic images were compared.

Results: Thirteen eyes (81%) in the inverted group and 15 eyes (93%) in the removed group had retinal reattachment after the initial surgery (P = 0.30). The MH was closed significantly more often in the inverted group (75%) than in the removed group (25%; P = 0.006). The postoperative best-corrected visual acuity was significantly better in the inverted group (P = 0.04). The number of eyes with outer nuclear layer, external limiting membrane, and ellipsoid zone lines at the closed MH was not significantly different in the two groups.

Conclusion: The inverted ILM flap technique with the presence of bridging tissue over the MH is effective in closing the MH and improving the postoperative best-corrected visual acuity in eyes with MH retinal detachment by bridging tissue over the MH.

The results showed that the inverted internal limiting membrane flap technique had higher macular hole closure rates and better visual outcome than the complete removal of the internal limiting membrane in eyes with a macular hole retinal detachment.

Kyorin Eye Center, Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.

Reprint requests: Makoto Inoue, MD, Kyorin Eye Center, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan; e-mail:

None of the authors has any financial/conflicting interests to disclose.

Involved in management, analysis, interpretation, and preparation of the data (H.T., M.I., T.K., Y.I., K.H., and A.H.). Involved in interpretation and preparation of the manuscript (H.T., M.I., and A.H.).

The corresponding author (M.I.) had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

© 2018 by Ophthalmic Communications Society, Inc.