Comparison of internal limiting membrane peeling and flap removal to flap insertion on visual outcomes in highly myopic eyes with macular hole retinal detachment.

INTRODUCTION: To compare the morphological and visual outcomes after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and flap removal to that with flap insertion in eyes with myopic macular hole retinal detachment (MHRD). METHODS: Forty-six eyes of 45 patients with a MHRD were studied. Eighteen eyes were treated by PPV with ILM peeling and flap removal, and 28 eyes by flap insertion. The baseline characteristics and postoperative findings were compared between the two groups. RESULTS: The average age of the cases was 70.0±8.5 years. The best-corrected visual acuity (BCVA) was improved from 1.51±0.14 to 1.31±0.20 logMAR units in the flap removed group and from 1.20±0.10 to 0.88±0.10 logMAR units in the flap insertion group (P=0.049). A significantly larger number of MHs was closed in the insertion group (96%) than in the removed group (50%, P<0.001). The restorations of the ellipsoid zone (EZ) and external limiting membrane (ELM) were also better in the flap insertion group than in the flap removed group (EZ, 6% vs 14%, P=0.003; ELM, 6% vs 36%, P<0.001). DISCUSSION/CONCLUSION: The technique of ILM peeling with flap insertion is more effective in closing the MH, results in better BCVA, and better restoration of the outer retinal microstructures than flap removal.