Macular Internal Limiting Membrane Imbrication Technique for Foveal Detachment in Myopic Traction Maculopathy- A Case Report by Joon Hyung Yeo, June-Gone Kim, South Korea



The development of a full-thickness macular hole (FTMH) is a serious complication in myopic traction maculopathy (MTM), especially in a case of foveal detachment, after vitrectomy. Although the mechanisms of why and how FTMHs develop postoperatively have not been fully determined, we hypothesized that internal limiting membrane (ILM) peeling will increase the risk of developing a FTMH. This hypothesis prompted us to develop a new technique of ILM peeling for foveal detachment in MTM to reduce a risk of surgical trauma on a thinned central fovea and to prevent a postoperative FTMH or foveal thinning. In this study, we introduce a new technique of ILM peeling for foveal detachment in MTM, which we called macular ILM imbrication technique.


The clinical course of a case was retrospectively evaluated according to a chart review.


A 62-year-old woman with pathologic myopia was referred to our clinic because of blurring of vision and metamorphopsia of the left eye that had persisted for 2 months. On examination, his decimal best corrected visual acuity (BCVA) was 0.3 in the left eye and FC 20cm in the right eye. Slit-lamp examination of the anterior segment was unremarkable. Fundus examination demonstrated tessellated fundus and posterior staphyloma in both eyes and chorioretinal atrophy in right eye. The spectral domain optical coherence tomography (SD-OCT) revealed a foveal detachment with retinoschisis and without detectable full-thickness macular hole. The patient underwent 23-gauge pars plana vitrectomy under general anesthesia. First, the central vitreous core was removed, and then the posterior hyaloid was removed by active suction using a vitreous cutter. The ILM was stained with indocyanine green (ICG) under near total fluid air exchange. Immediately after the ICG application, the ICG was rinsed out with infusion fluid and the residual dye was aspirated. And ILM was grasped with an ILM forceps and peeled off in a circular fashion away from the central fovea. During the circumferential peeling, the ILM was not removed completely from the retina but was left attached to the fovea. When the peeled ILM flap comes close to the fovea, multiple ILM flap was made by peeling the ILM from the new site. After the ILM was peeled from the entire macula area except the foveal area, the peeled ILM was imbricated on the ILM attached to the fovea to build a double-roof ILM. At the end of surgery, the vitreous cavity was filled with air. And sh e was instructed to avoid supine and to maintain a prone position postoperatively for at least 1 week. One month after surgery, the foveal detachment was flattened, although still present, and the retinoschisis was decreased. During the next 3 months, BCVA improved to 0.4 and the foveal detachment, retinoschisis were further reduced and a postoperative FTMH was not developed until her last follow-up.


Our case suggests that PPV with macular ILM imbrication technique may be successful in the management for foveal detachment in MTM. Longer-term follow-up study with large population will be necessary to clarify the usefulness and safety of macular ILM imbrication technique.



Joon Hyung Yeo, June-Gone Kim
Asan Medical Center, University of Ulsan College of Medicine
South Korea
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