Inverted internal limiting membrane flap technique for very large macular hole

AIM: To assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 pm using the inverted internal limiting membrane flap technique. METHODS: This retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 mu M who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure. RESULTS: Mean age was 63.2 +/- 8.4y with all 5 subjects being females. Mean duration of symptoms was 11 +/- 14mo with a mean postoperative follow up of 13.2 +/- 13mo. The mean base diameter of the macular holes was 1420 +/- 84.8 mu m (1280-1480 mu m). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen's equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen's equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted. CONCLUSION: The inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.