Internal limiting membrane flap over the inner retinal clefts for macular detachment associated with intrachoroidal cavitation

Purpose To report our findings in a patient with a macular detachment associated with an intrachoroidal cavitation (ICC). The macula was reattached by covering the paravascular inner retinal clefts with the inverted internal limiting membrane (ILM) flap. Observations A 56-year-old man was referred to our clinic for treatment of a macular detachment. His best-corrected visual acuity (BCVA) in the left eye was 20/50 with a correction of −10.0 diopters (D) and 20/20 in the right eye. Fundus examination revealed orange-colored peripapillary lesions superior and inferior to the optic disc and peripapillary atrophy in the left eye. The optical coherence tomographic (OCT) images showed a macular detachment that was connected to the optic disc, and two paravascular inner retinal clefts connected to the ICCs. Pars plana vitrectomy was performed to create a posterior vitreous detachment, and the vitreous cortex and the internal limiting membrane (ILM) above the peripapillary atrophy were peeled, inverted, and folded toward the optic disc. Then, the inverted ILM tissue was divided and placed over the inner retinal clefts guided by the intraoperative OCT images. Then, 20% SF6 gas was injected to tamponade the inverted ILM tissue against the inner retinal clefts, and the patient was instructed to maintain a prone position for 3 days. The macular detachment was gradually resolved after 8 months, and the BCVA improved to 20/25. Conclusions and importance A combination of vitrectomy with the inverted ILM flap covering the inner retinal clefts was successful in reattaching a macular detachment associated with an ICC.