Macular hole closure patterns associated with different internal limiting membrane flap techniques

To compare the anatomic and functional outcome of two variants of the inverted internal limiting membrane (I-ILM) flap technique for idiopathic macular holes (IMH) larger than 400 A mu m. Twenty-seven consecutive patients undergoing PPV for IMH were randomly assigned to different variants of I-ILM technique: the Cover group included 14 patients in which the I-ILM was folded upside-down over the MH as a single layer while the Fill group enrolled 13 patients in which the I-ILM was folded within the MH in multiple layers. MH closed in 12/14 Cover and in 13/13 Fill eyes (84.6 vs. 100%, p = 0.14; n.s.). Vision at 1 month was Snellen 0.44 +/- 0.17 vs. 0.28 +/- 0.21 (p = 0.05) and 0.48 +/- 0.20 vs. 0.37 +/- 0.25 (n.s.) at 3 months. IS/OS line interruption width was 463 +/- 385 vs. 602 +/- 210 A mu m, respectively, at 1 month (n.s.) and 602 +/- 210 vs. 563 +/- 209 A mu m at 3 months (n.s.). The Cover group showed outer retina cystic changes more often (p < 0.01). MH over 700 A mu m closed in 0/2 and in 2/2 cases, respectively, in the Cover and Fill groups (0.045). Cover and Fill I-ILM techniques allowed similar closure rates and post-operative vision at 3 months. The Cover group showed better anatomical restoration and vision at 1 month while the Fill technique might be more efficient in closing larger MHs.