Abstract
Primary closure of large macular holes remains challenging, and variations of inverted inner limiting membrane (ILM) flap surgery have been described. In the present retrospective,
interventional, single-centre case series, we propose a superior flap design with minimal posturing. Eight eyes of eight patients (four women and four men) in the period between July 2020
and March 2022 underwent 23 G three-port vitrectomy with a superior inverted ILM flap and 20% SF6 endotamponade for a full thickness macular hole (MH) by the same experienced
surgeon (F. M. H.). Seven MHs were classified as large (> 400 µm) and one as medium (250 – 400 µm). The mean MLD was 638.0 ± 166.4 µm (range: 353 – 851 µm). MH closure was achieved in all
(8/8, 100%) patients with a single surgery. The median best-corrected visual acuity (BCVA) improved from 6/120 (Snellen) (range: finger counting [FC] to 6/19) preoperatively to 6/19 (range:
FC to 6/9.5) after surgery, without any intra- or postoperative complications. The superior inverted ILM flap technique seems to be a safe and successful approach for the primary closure of
large MHs. Further studies should investigate our proposed surgical technique on a larger population, potentially without air or gas endotamponade.
Key words
macular hole - vitreoretinal surgery - internal limiting membrane
