Internal limiting membrane flap and insertion techniques improve prognosis in macular hole-associated retinal detachment

Ke Zhu; Boya Lei; Ling Wang; Ling Chen; Yingqin Ni; Yanqiong Zhang; Xin Huang; Qing Chang; Gezhi Xu

doi:10.1016/j.oret.2025.07.006

Internal limiting membrane flap and insertion techniques improve prognosis in macular hole-associated retinal detachment

Ophthalmol Retina. 2025 Jul 11:S2468-6530(25)00316-1. doi: 10.1016/j.oret.2025.07.006. Online ahead of print.

Authors

Ke Zhu¹, Boya Lei¹, Ling Wang¹, Ling Chen¹, Yingqin Ni¹, Yanqiong Zhang¹, Xin Huang¹, Qing Chang¹, Gezhi Xu²

Affiliations

¹ Eye Institute and Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China; Key Laboratory of Myopia and Related Eye Diseases, NHC; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China.
² Eye Institute and Department of Ophthalmology, Eye and Ear Nose Throat Hospital of Fudan University, Shanghai, China; Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China; Key Laboratory of Myopia and Related Eye Diseases, NHC; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China. Electronic address: drxugezhi@163.com.

PMID: 40653047
DOI: 10.1016/j.oret.2025.07.006

Abstract

Purpose: To compare the long-term anatomical and visual outcomes of macular hole (MH)-associated retinal detachment (MHRD) treated with internal limiting membrane (ILM) peeling, ILM insertion, or inverted ILM flap techniques.

Design: Retrospective and comparative study PARTICIPANTS: 288 patients with MHRD who underwent pars plana vitrectomy and ILM technique were enrolled at the Eye and ENT Hospital of Fudan University.

Methods: 295 eyes were divided into ILM peeling (138 eyes), ILM insertion (54 eyes), and ILM flap (103 eyes) groups, and subdivided according to the extent of retinal detachment, non-high/high myopia, proliferative vitreoretinopathy (PVR) grade and chorioretinal atrophy (CA) grade. The initial retinal reattachment rate, MH closure rate, postoperative best-corrected visual acuity (BCVA), and improvement in BCVA were evaluated.

Main outcome measures: Anatomical and visual outcomes of MHRD treated with ILM peeling, insertion or flap techniques.

Results: The ILM flap and insertion techniques were associated with significantly better initial MH closure rate than ILM peeling (91% vs. 87% vs. 54%, P < 0.001) along with a greater BCVA improvement (P < 0.001). The proportion of eyes with BCVA improvement was higher for the ILM flap technique than for ILM insertion (96% vs. 83%, P < 0.005). In eyes with non-high myopia (AL <26 mm), the ILM flap technique demonstrated better postoperative BCVA improvement than ILM peeling, but without an anatomical advantage. In eyes with PVR grade C or CA grade 4, the ILM flap technique achieved greater MH closure rates than ILM peeling, but without visual benefits. Retinal detachment extending beyond the arcade, the ILM insertion and ILM flap techniques were significantly associated with MH closure (P = 0.011, 0.001, and P < 0.001, respectively). Preoperative BCVA, retinal detachment beyond the arcade, CA grade, ILM insertion technique, and ILM flap technique were independently associated with the BCVA improvement (P = 0.003, 0.009, 0.006, 0.014 and P < 0.001, respectively).

Conclusions: The ILM insertion and flap techniques were associated with greater MH closure rates and BCVA improvements compared with the ILM peeling technique for the treatment of MHRD. The ILM flap technique outperformed the ILM insertion technique in terms of functional recovery.

Keywords: Best-corrected visual acuity; Internal limiting membrane techniques; Macular hole closure; Macular hole-associated retinal detachment.