The ILM envelope technique is a novel procedure for management of myopic macular hole retinal detachment. It entails peeling the ILM from 4 directions: the upper & lower temporal arcades, nasal edge of the optic disc and 2 disc diameters temporal to the macula. The peel stops well away from the edge of the macular hole. Under air or PFCL, the ILM flaps are folded over the hole, like folding an envelop. Further ILM peeling is done to the edge of the posterior staphyloma. Following excision of the basal gel, the eye is f illed with air. Face down position is adopted for 5 days. Using this technique in 19 eyes, successful retinal reattachment, hole closure and improvement of visual acuity could be achieved in 100%. 60% showed progressive improvement of visual acuity.

This technique has the following advantages: Complete relieve of tangential traction peeling the rigid ILM; confirmed placement of the ILM flaps over the macular hole, no liability for flap displacement or reversion; only air is needed as internal tamponade and progressive improvement of visual outcome in 60%.


Cairo University
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