Inverted Autologous Internal Limiting Membrane for Management of Optic Disc Pit with Macular Detachment
A 41-year-old female presented with a history of decreased vision in her left eye for 1 year. The best correctable visual acuity in that eye was 6/60. Anterior segment examination showed cortical cataractous changes. The intraocular pressure (IOP) was 16 mmHg. The left fundus showed an optic disc pit along-with a large macular detachment []. Ocular coherence tomography (OCT - Stratus III, Carl Zeiss, Dublin, USA) of the macula was performed, which confirmed the clinical finding [Figures and ]. The right eye was normal.\nThe patient was counseled on the available treatments. Then, we discussed the new technique which we were going to adopt for her surgery. The patient was also informed about the use of brilliant blue dye to stain the ILM during surgery. The patient signed an informed consent which contained all the details of the proposed surgical.\nThe patient underwent combined phacoemulsification and in-the-bag implantation of intraocular lens (+23.00 Diopter, Acrysof IQ, Alcon Laboratories, Tx, USA) and pars plana vitrectomy (PPV) combined with peeling of ILM. PPV was carried out with a 23-G sutureless technique. After initial core vitrectomy, triamcinolone assisted posterior hyaloid removal was performed. The ILM was stained with brilliant blue stain (Fluoron GmbH, Magirus-Deutz).\nThe stained ILM between the temporal vascular arcades was peeled in a manner that it was removed as a single sheet keeping the part adjacent to the superotemporal edge of optic disc still attached in a pedicle like fashion, as used in skin graft surgery [Figures and ]. Then, the peeled ILM flap was inverted with 23-G ILM-forceps and reflected over the optic disc [Figures and . Fluid-air exchange was then carried out keeping the silicone tipped back-flush cannula just medial to the free edge of the inverted flap thus preventing the displacement of the inverted ILM from the optic disc. Finally, intravitreal air was exchanged with non-expansile concentration (14%) of octafluoropropane (C3F8). At the end surgery, the patient was discharged with instruction to lie face down for 1 week, postoperatively.\nThe patient was examined on the first postoperative day, at 7 days, 2 weeks, monthly intervals for the next 3 months; and then at 3-month intervals. Examinations at every visit included visual acuity, anterior segment assessment, measurement of IOP, and clinical evaluation of the posterior segment. OCT examination of the optic nerve and macula were performed once the gas bubble cleared the macular area when the patient was sitting.\nThe macular detachment regressed completely at 1 month [Figures and ]. Postoperatively, the best corrected visual acuity improved to 6/24 at one month and to 6/12 at 3 months, which was maintained out to10 months (last visit to date). Although it was clinically difficult to assess the newly relocated ILM, the postoperative OCT examination confirmed coverage of optic pit by the inverted ILM [].