Multilayered inverted internal limiting membrane flap technique versus standard internal limiting membrane peeling for large macular holes: A comparative study

Purpose: To evaluate the outcome of vitrectomy with multilayered inverted internal limiting membrane flap technique (ML-IILM) versus vitrectomy with standard ILM peeling for large macular holes in terms of visual acuity and anatomical closure. Methods: A hospital-based, prospective, randomized, interventional study was conducted during three calendar years with a total 150 eyes (75 in each group) in two groups-vitrectomy with ILM peeling (Group A) and vitrectomy with ML-IILM flap technique (Group B) after informed consent of study participants who met the inclusion criteria. Results: The mean minimum and maximum diameter of macular hole did not differ statistically in both the groups. Macular hole index had no significant difference between both groups Pre-operative visual acuity was not statistically significantly different between the two groups. During follow-up, best corrected visual acuity (BCVA) at 1 month, 3 months, 6 months, and 12 months was significantly better in Group B (0.12 +/- 0.07 at 1 month, 0.14 +/- 0.10 at 3 months, 0.18 +/- 0.11 at 6 months, and 0.19 +/- 0.12 at 12 months) compared to Group A (0.20 +/- 0.11 at 1 month, 0.22 +/- 0.13 at 3 months, 0.30 +/- 0.12 at 6 months, and 0.31 +/- 0.14 at 12 months) (P = 0.001 for each). Type 1 anatomical closure (flattening of cuff and opposition of edges of hole) was achieved in 78.66% (59/75) cases in Group A and 93.33% (70/75) cases in Group B (P 0.0016). Conclusion: Vitrectomy with multilayered inverted ILM flap technique had significantly higher anatomical closure and better visual outcome than vitrectomy with standard ILM peeling.

Automated summary

The multilayered inverted internal limiting membrane flap technique (ML-IILM) had significantly higher anatomical closure and better visual outcome compared to standard internal limiting membrane peeling in vitrectomy for large macular holes.