Combined Treatment With Inverted Internal Limiting Membrane Flap and Subretinal Injection of Balanced Salt Solution to Repair Chronic Macular Holes

<b>Purpose:</b> To present a surgical technique that combines an inverted internal limiting membrane (ILM) flap and subretinal injection of balanced salt solution for the closure of chronic macular holes (MHs). <b>Methods:</b> Two cases were evaluated. <b>Results:</b> A 74-year-old man and a 63-year-old woman presented with decreased visual acuity (VA) of 20/600 and 20/200, respectively, resulting from a chronic MH. Both patients had vitrectomy, during which the ILM flap was inverted and a 38-gauge subretinal needle was used to inject balanced salt solution near the vascular arcade, creating a retinal bleb. Injection of the balanced salt solution into the MH with a backflush needle completed the detachment. The MH was then closed by a gas tamponade with improvements in VA in both patients to 20/50 and 20/40, respectively. <b>Conclusions:</b> The combined inverted ILM flap and subretinal injection of balanced salt solution into the MH, extending the detachment, led to the successful closure of a chronic MH.