J Korean Ophthalmol Soc.  2021 Dec;62(12):1672-1678. 10.3341/jkos.2021.62.12.1672.

Exhibiting Residual Subretinal Fluid after High Myopic Macular Hole Retinal Detachment Surgery

• Kim SJ
• Lee JJ
• Byon IS
• Lee JE
• Park SW

• KMID: 2523323
• DOI: http://doi.org/10.3341/jkos.2021.62.12.1672

Abstract

Purpose
To report a case of poor visual prognosis complicated by residual subretinal fluid after use of the internal limiting membrane flap technique to treat macular hole retinal detachment in a patient with high myopia.
Case summary
A 55-year-old male stated that he had experienced a transparent circle in the central visual field of the right eye for 1 month. His best-corrected visual acuity (BCVA) was 0.32 and the axial length of the right eye was 32.57 mm. Fundus examination revealed a macular hole with retinal detachment localized to the posterior pole. We performed vitrectomy, membrane peeling, internal limiting membrane peeling with inverted internal limiting membrane flap, and silicone oil injection. On day 1 after surgery, the macular hole was closed, but subretinal fluid was noticed in the macula. At 3 months after surgery, the BCVA was 0.16 and the silicone oil was removed. At 14 months after the first surgery, the subretinal fluid was completely absorbed, but leopard-pattern pigment degeneration became prominent and the macula exhibited ellipsoid zone disruption. The BCVA decreased to 0.1.
Conclusions
In patients exhibiting macular hole retinal detachment in the context of high myopia, an inverted internal limiting membrane flap may increase the macular hole closure rate but disturb subretinal fluid drainage. As persistent subretinal fluid may cause permanent retinal damage with a poor visual prognosis, the surgical method must be carefully chosen.

Keyword

Inverted internal limiting membrane flap, Macular hole, Retinal degeneration, Retinal detachment, Subretinal fluid