Kawamata Yuto, Baba Takayuki, Yokouchi Hirotaka, Yamamoto Shuichi
Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Japan.
Am J Ophthalmol Case Rep. 2021 Apr 14;22:101089. doi: 10.1016/j.ajoc.2021.101089. eCollection 2021 Jun.
To report a case in which an internal limiting membrane (ILM) flap that was used to cover an idiopathic macular hole (MH) during pars plana vitrectomy (PPV) with the inverted internal limiting membrane flap technique partially detached from the retina. Most interestingly, the flap fell back spontaneously to re-cover the MH.
A 70-year-old woman presented with a full-thickness MH, and her vision was 20/400. She underwent PPV with an inverted ILM flap and air tamponade. When the intraocular gas was absorbed, the ILM flap detached but was held to the retina where it had not been peeled and the MH was open. Her visual acuity at this time was 20/400. The patient did not want further treatment and was followed by observation alone. At three months after the initial surgery, the ILM flap was noted to have spontaneously re-covered the MH, and her visual acuity improved to 20/200. At 6 months after the re-covering, the flap remained over the MH and the visual acuity remained at 20/200.
Surgeons should be aware that it is possible for an ILM flap created by the inverted ILM flap technique to partially detach from the retina after the tamponade gas is resorbed. Most importantly, the flap can return to re-cover the MH spontaneously.
报告1例在玻璃体切割术（PPV）中采用内界膜（ILM）翻转瓣技术覆盖特发性黄斑裂孔（MH）时，ILM瓣部分与视网膜分离的病例。最有趣的是，该瓣片自行回落，重新覆盖了黄斑裂孔。
一名70岁女性，患有全层黄斑裂孔，视力为20/400。她接受了PPV联合ILM翻转瓣和空气填塞术。当眼内气体吸收后，ILM瓣分离，但仍附着于未被剥离的视网膜处，黄斑裂孔开放。此时她的视力为20/400。患者不希望进一步治疗，仅进行观察随访。初次手术后3个月，发现ILM瓣自行重新覆盖了黄斑裂孔，其视力提高到20/200。重新覆盖后6个月，瓣片仍位于黄斑裂孔上方，视力维持在20/200。
外科医生应意识到，采用ILM翻转瓣技术制作的ILM瓣在填塞气体吸收后可能会部分与视网膜分离。最重要的是，该瓣片可自行回落重新覆盖黄斑裂孔。
