Viscoat Assisted Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes Associated with High Myopia

Figure 1

Schematic drawings showing the Viscoat assisted single-layered inverted internal limiting membrane (ILM) flap technique. (a) After performing a 23-gauge 3-port pars plana vitrectomy, Viscoat is injected into the macular hole (MH) and its mirror symmetrical area superior to MH. (b) Indocyanine green (ICG, 0.125% solution) is then applied around the MH within the arcade to stain the ILM. Excessive ICG as well as Viscoat is removed by suction. (c) The ILM is peeled off in a circular fashion for approximately 2.5 disc diameters around the MH. The inferior ILM is completely peeled off, while the superior ILM is not removed completely but left attached to the edge of the MH, forming an ILM flap of about 1 disk diameter. (d) Viscoat is injected and smeared in an arch around the MH in the lower half part of the macular as an adhesive. (e) The ILM flap is flipped by inverting it using the intraocular forceps to cover the whole MH and gently massaged to make it flattened. (f) Supplementary Viscoat is applied on top of the inverted ILM flap as ballast before air-fluid exchange is performed.

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