Effectiveness of vitrectomy with inverted internal limiting membrane flap in the treatment of macular hole retinal detachment in high myopia

Purpose This study evaluates the effectiveness of the inverted internal limiting membrane (ILM) flap technique during vitrectomy for treating macular hole-induced retinal detachment (MHRD) in high myopia patients, a challenging complication for vitreoretinal surgeons due to its treatment complexity. Methods We conducted a prospective study analyzing 92 eyes diagnosed with MHRD, all undergoing vitrectomy using the inverted ILM flap technique between February 2022 and September 2024. Successful surgery was defined as achieving retinal reattachment, macular hole closure, and improvement in visual acuity by the 12-month postoperative follow-up. Microstructural recovery was assessed using spectral domain optical coherence tomography. Logistic regression analysis was performed to identify prognostic factors of surgical outcome. Results Of the 92 eyes, 94.6% achieved retinal reattachment, and 92.4% experienced macular hole closure. Visual acuity significantly improved in 91.3% of cases, with a mean improvement of 0.95 logarithm of the minimum angle of resolution. Recovery rates for the external limiting membrane, the ellipsoid zone, and the cone outer segment tip were 76.1%, 66.3%, and 66.3%, respectively. Larger retinal detachments and macular holes were important predictors of lower surgical success (p < 0.001; p = 0.015, respectively). There was a significant correlation between vision improvement and the recovery of structural integrity and foveal microstructures. Conclusions The ILM coverage technique represents a breakthrough in the treatment of MHRD, promoting both anatomical and functional recovery. This approach enhances the management of this complex condition, ultimately improving the quality of life for affected individuals.