Combined Surgically Induced Macular Detachment and Autologous Internal Limiting Membrane Transplantation for Refractory Full Thickness Macular Hole

<b>Background/Objectives</b>: To propose a combined surgery of surgically induced macular detachment (MD) and autologous internal limiting membrane (ILM) transplantation to treat refractory full thickness macular holes (FTMHs). <b>Methods</b>: A series of patients affected by refractory FTMHs underwent a combined surgery. The following demographic and clinical data were collected: age, gender, eye, lens status, and best corrected visual acuity (BCVA). The tomographic pre- and post-operative parameters were the following: pre-operative FTMH diameter, refractory FTMH morphology (flat/with cuff), FTMH closure, foveal profile (regular/flat/inverted), flap displacement, and outer retinal layers restoration. <b>Results:</b> The study included a total of 14 pseudophakic eyes (14 patients). In all of the patients, surgical FTMH closure was reached. The mean BCVA improved after surgery from 1.1 ± 0.14 to 0.48 ± 03 logMAR (<i>p</i> < 0.0001). Statistical analysis demonstrated that the larger the FTMH, the poorer the post-operative gain in BCVA (<i>p</i> -0.5). The post-operative regular foveal profile was obtained in 50% of the eyes with a mean post-operative BCVA of 0.3 logMAR. A negative correlation between the time interval from diagnosis to surgery and post-operative BCVA gain was highlighted (<i>p</i> -0.8). <b>Conclusions</b>: The proposed combined surgical technique led to encouraging anatomical and functional results. Surgically induced MD increased the elasticity of the retina, and the free flap isolated the macular hole from the vitreous chamber favoring its closure.