Inverted Internal Limiting Membrane Flap plus Fovea-Sparing Peeling and Repositioning: A Novel Approach for Myopic Traction Maculopathy

PURPOSE: To examine the efficacy and safety of IPS procedure-comprising an inverted internal limiting membrane (ILM) flap, fovea-sparing peeling and repositioning assisted by the sub-perfluoro-n-octane injection of an ophthalmic viscoelastic device-in eyes with myopic traction maculopathy (MTM) and a high risk of postoperative full-thickness macular hole (FTMH) formation. METHODS: This retrospective, consecutive and interventional case series included eight MTM cases with lamellar macular hole and foveal detachment (FD). All patients underwent vitrectomy with IPS procedure and gas tamponade, with a minimum follow-up of 6 months. RESULTS: Between April and November 2024, eight consecutive eyes underwent IPS, with a median follow-up of 414 days. The cohort included two men (25%) and six women (75%), with a mean age of 62 years and a mean axial length of 29.83 mm. Mean visual acuity improved from 0.54 to 0.23 logMAR (Snellen equivalent, 20/70 to 20/35), and mean central foveal thickness decreased from 571.6 µm to 279.5 µm. No eyes developed postoperative FTMH. Retinoschisis was completely resolved in five eyes (62.5%), and FD was reversed in five out of six eyes (83.3%). Inner retinal dimples were noted in four eyes (50.0%) and were confined to areas exposed by the inverted ILM flap, with no inner retinal dimples in the ILM-repositioning area. CONCLUSION: IPS relieves traction, restores ILM integrity, minimizes inner retinal surgical trauma, and protects an ultrathin fovea, thereby reducing the risk of post-vitrectomy FTMH and achieving functional and morphologic improvements in patients with MTM at high risk for postoperative FTMH.