Novel Technique for Macular Hole-Associated Retinal Detachment With the Inverted Internal Limiting Membrane Flap Technique Under Perfluorocarbon Liquid

Purpose: To describe the technique and surgical outcomes of a modified inverted internal limiting membrane (ILM) flap technique, using perfluorocarbon liquid (PFCL) without creating iatrogenic retinal breaks in the management of macular hole-associated retinal detachment. Methods: This retrospective study was approved by the Ethics Committee of Akita University Hospital. Eight patients with macular hole-associated retinal detachment underwent pars plana vitrectomy with the novel PFCL-assisted inverted ILM flap technique. Subretinal fluid was drained through the macular hole using a soft-tip needle, and ILM staining was performed after fluid–air exchange. PFCL was applied to stabilize the retina, and ILM peeling was completed under PFCL with improved visibility. The procedure concluded with air–fluid exchange and tamponade using silicone oil or gas. Patients maintained a face-down position postoperatively for 1 day. Results: All eight patients achieved initial retinal reattachment and macular hole closure without intraoperative or postoperative complications. After 12 months of follow-up, macular hole closure and retinal reattachment were maintained in all cases. Conclusion: This novel technique avoids iatrogenic breaks, reducing epiretinal membrane risk and secondary macular hole formation. The PFCL-assisted ILM manipulation ensures stability and minimizes retinal damage. The method is safe, effective, and promising for macular hole-associated retinal detachment treatment in this small series.