Visual and anatomical outcome of inverted ILM flap technique for large macular hole surgery

A new study finds that in about 14-16% of macular hole repairs using the inverted internal limiting membrane (ILM) flap technique, the hole actually closes itself thanks to a thin layer of the ILM left behind, not the full flap itself. This suggests a potentially simpler closure mechanism for this surgery. This study was conducted to investigates both the physical results (anatomy) and vision improvements experienced by patients who underwent large macular hole surgery using the inverted internal limiting membrane (ILM) flap technique. : 20 patients with significant macular defects participated in the research from January 2019 to December 2019 at the Ispahani Islamia Eye Institute and Hospital. Idiopathic large macular lesions were analyzed in the study using optical coherence tomography (OCT) and biomicroscopy. Exclusion criteria excluded macular holes measuring less than 400 μm and those resulting from other etiologies. Demographic and clinical information was collected, including age, gender, best-corrected visual acuity (BCVA), and intraocular pressure. Slit-lamp biomicroscopy was performed on the anterior region and fundus, and spectral-domain optical coherence tomography (OCT) was used to verify the presence of macular holes. Approval from the institutional ethical committee was obtained, and surgical procedures were performed after informed consent. The final best-corrected visual acuity was documented, and a comprehensive ocular assessment was conducted during appointments. In this study half (50.0%) of patients belonged to those aged≥51 years. The mean age was 41.40±17.87 years with ranged from 20 to 60. Here it was observed that the mean BCVA pre-operative was 1.39±0.65 and the mean BCVA (3 months after surgery) was 0.50±0.16. In OCT all (100.0%) patients had macular holes before surgery and 100.0% closure of MH after surgery. Here ERM is formed in only 1(10.0%) patient. The study found a 100% closure rate for macular holes and superior functional outcomes. Further research is needed to assess the efficacy of this approach with a larger sample size and longer follow-up duration.