Perfluorodecalin and Viscoelastic-Assisted Internal Limiting Membrane Flap Technique for High Myopia Macular Hole Retinal Detachment

Purpose: To evaluate the feasibility and outcomes of a novel surgical technique using a sub-perfluorodecalin (PFD, RT DECALIN) injection of ophthalmic viscosurgical device (OVD) to stabilize inverted internal limiting membrane (ILM) flaps for the treatment of macular hole retinal detachment (MHRD) in highly myopic eyes. This technique addresses the challenges of ILM flap displacement and stability. Patients and Methods: This retrospective, interventional case series included seven eyes of seven patients with MHRD who underwent surgery using sub-PFD injection of OVD to stabilize inverted ILM flaps. Pre- and postoperative best-corrected visual acuity (BCVA) was compared using the Wilcoxon signed-rank test. Ethical approval was obtained, and all patients provided informed consent. Fundus color photography and optical coherence tomography (OCT) were used to assess anatomical outcomes. Results: The study included seven eyes of seven patients (mean age: 61.86± 4.30 years; follow-up: 6 months). All eyes achieved successful macular hole closure, with near-normal foveal contour observed in five (71.43%) eyes at the final follow-up. BCVA improved significantly from 2.03± 0.38 logMAR to 1.20± 0.54 logMAR (P = 0.0024). No intraoperative or postoperative complications were observed. Conclusion: Sub-PFD injection of OVD for stabilization of the inverted ILM flap was feasible and was associated with favorable short-term anatomical outcomes in highly myopic eyes with MHRD. Improvement in BCVA was also observed during follow-up. This innovative approach offers a promising solution to the challenges associated with MHRD in highly myopic eyes. Keywords: MHRD, optical coherence tomography, anatomical closure, pathologic myopia