Inverted internal limiting membrane flap technique for macular hole retinal detachment in high myopia compared to internal limiting membrane peeling.

Macular hole (MH) retinal detachment (MHRD) frequently causes severe visual impairment, mainly in older people with severe myopia and posterior staphyloma. Vitrectomy combined with internal limiting membrane (ILM) peeling is a treatment but has issues. The usefulness of an ILM inverted flap technique has not been clearly defined. Thus, we compared vitrectomy using this technique with vitrectomy using a complete ILM peeling technique for MHRD with severe myopia. The study included 29 patients (29 eyes) who underwent initial vitrectomy for MHRD with severe myopia between January 2011 and August 2019. The inverted ILM flap technique was used in 12 eyes (inverted group), and the complete ILM peeling technique was used in 17 eyes (peeling group). Clinical findings and outcomes were compared. In the peeling and inverted groups, the initial MH closure rate was 35.3% and 50% (p = 0.024) and the initial retinal reattachment rate was 82.4% and 75.0% (p = 0.630), respectively. The final retinal reattachment rate was 100% in both groups. The postoperative visual acuity during final consultation was better in the inverted than the peeling group. The inverted ILM flap technique may be more useful than the ILM peeling technique for MHRD in severely myopic eyes.