Hole Closure in Vitrectomy with internal limiting membrane repositioning and autologous blood for Macular hole retinal detachment repair in High myopes

Prospective interventional cohort study of 30 eyes of 30 consecutive patients with high myopia and MHRD if they satisfy the inclusion and exclusion criteria, will be invited to join the study and if they agree, will sign the consent form. Best-corrected visual acuity, refraction, slit lamp examination, lens status, intraocular pressure, fundus examination, fundus photo, axial length and optical coherence tomography findings will be documented before surgery. All patients will be operated under regional or general anaesthesia by the investigators. Combined cataract surgery and intraocular lens implantation will be done when indicated. Standard 3-port 23G vitrectomy followed by Internal limiting membrane (ILM) peeling with ILM Blue and with remnants at the hole edge for creation of an ILM clump repositioned into the macular hole. Fresh blood will be obtained from the patient’s antecubital vein, and injected gently to cover the macular hole. The fresh blood will soon become a clot on the surface of the repositioned ILM filling the macular hole, and seal it. Air-fluid exchange will be done without intentional drainage of subretinal fluid through the macular hole. In cases of extensive retinal detachment extending well beyond the vascular arcades, an extramacular retinotomy may be created at the discretion of the investigator to drain subretinal fluid to facilitate further procedures such as laser photocoagulation. Gas-air exchange will be performed with gas tamponade by 12-14% C3F8 at the end of surgery. Postoperatively, the patients will be asked to remain in a prone position for 3 days and to avoid the supine position afterward during the follow-up period until the gas is absorbed. Procedure is performed by an experienced vitreoretinal surgeon. The approximate duration of the procedure is about 90 minutes.