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Surgical Technique |

Autologous Neurosensory Retinal Free Flap for Closure of Refractory Myopic Macular Holes

Dilraj S. Grewal, MD1; Tamer H. Mahmoud, MD, PhD1
[+] Author Affiliations
1Duke Eye Center, Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
JAMA Ophthalmol. 2016;134(2):229-230. doi:10.1001/jamaophthalmol.2015.5237.
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This Surgical Technique describes the use of an autologous neurosensory retinal free flap for closure of refractory myopic macular holes with associated foveoschisis and/or retinal detachment.

Macular holes (MHs) in highly myopic patients often develop at a younger age and may be associated with foveoschisis and a posterior retinal detachment (RD), which portend a poorer prognosis. Although recent anatomical success following primary pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peel with gas tamponade have improved to 60% to 100%, closure rates are significantly lower if associated with foveoschisis or RD, the MH may attain a flat-open configuration even following retinal reattachment, and reopening rates are higher.1,2

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Figure.
Spectral-Domain Optical Coherence Tomography (OCT) Scan

Preoperative OCT shows a refractory 1100-μm full-thickness macular hole (inset) and postoperative OCT shows macular hole closure with overlying neurosensory retinal free flap (white arrowhead) with partial outer retinal band restoration postoperatively (yellow arrowhead).

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