Perfluorocarbon Liquid-Assisted Neurosensory Retinal Free Flap for Complicated Macular Hole Coexisting with Retinal Detachment

Purpose: To report the surgical results and technique of perfluorocarbon-assisted neurosensory retinal flap transplantation into macular hole for concomitant macular hole and complicated retinal detachment. Method: This is a retrospective, consecutive case series of 7 cases with concomitant macular hole and complicated retinal detachment with proliferative vitreoretinopathy. All eyes had previous vitrectomy and internal limiting membrane peeling, or very large (>1,000 mu m) macular holes. Perfluorocarbon liquid-assisted free neurosensory retinal flap transplantation into the macular hole, and subretinal fluid drainage through iatrogenic retinectomy/retinotomy were performed, followed by air-fluid exchange with gas or silicone oil tamponade. Results: All eyes had retina reattached. Macular hole was closed in all eyes, with the graft visualized by optical coherence tomography. The best corrected visual acuity in logarithm of minimal angle of resolution improved from 2.80 +/- 0.45 preoperatively to 1.40 +/- 0.51 postoperatively (p < 0.01). Conclusions: Neurosensory retinal flap may be a good option in closing macular holes in eyes with concomitant macular hole and complicated retinal detachment. Because of its specific properties, the flap is easy to handle during the operation. Retinectomy or retinotomy serves to release traction, drain subretinal fluid, and provide retinal flap tissue.