Combined Epiretinal Proliferation and Internal Limiting Membrane Inverted Flap for the Treatment of Large Macular Holes

We are presenting a new method for the treatment of large macular holes (MHs) with the use of an inverted flap consisting of both internal limiting membrane (ILM) and epiretinal proliferation (EP). A prospective interventional case series was conducted from September 2021 to January 2023. MH patients with coexistent EP visualized preoperatively in macula optical coherence tomography and with a MHs minimum linear diameter larger than 400 microns underwent standard pars plana vitrectomy with the creation of an inverted petaloid flap (consisting of both ILM and EP) and gas tamponade. Sixteen eyes were included in our case series. MHs closure was successful in all the eyes with a single procedure. The preoperative minimum linear diameter was 707.63 (±164.02 μm), and the preoperative best corrected visual acuity was 1.11 ± 0.52. The postoperative BCVA was 0.51 ± 0.20 (<i>p</i> = 0.01) at 6 weeks postoperatively, and the final BCVA was 0.45 ± 0.20 (<i>p</i> = 0.008). EP can be safely combined with ILM for the creation of an inverted, petaloid flap to cover and facilitate the closure of large MHs.