Intraoperative OCT-guided partial internal limiting membrane peeling combined with inferior flap coverage for the treatment of idiopathic macular holes: A prospective randomized controlled clinical trial

To evaluate the efficacy and safety of intraoperative optical coherence tomography (iOCT)-guided partial internal limiting membrane (ILM) peeling combined with inferior flap coverage for the treatment of idiopathic macular holes (IMH). This prospective, randomized, controlled clinical trial included patients with Gass stage 4 IMH, aged 50 or older, who had not undergone prior vitreoretinal surgery. Patients were randomized into 2 groups: the experimental group received iOCT-guided partial ILM peeling with inferior flap coverage, and the control group underwent standard ILM peeling. Outcome measures included best-corrected visual acuity, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), multifocal electroretinography, and microperimetry at 2 weeks and 6 months postoperatively. A total of 34 eyes were enrolled, with 18 in the experimental group and 16 in the control group. There was a significant improvement in best-corrected visual acuity and reduction in central foveal thickness in both groups, with no statistically significant differences between groups at any time point. The hole closure rate was also comparable, with 83.3% in the experimental group and 75.0% in the control group at 2 weeks, and 94.4% and 87.5% at 6 months, respectively. Functional outcomes, as measured by OCTA, microperimetry, and multifocal electroretinography, showed significant improvements in both groups without significant intergroup differences. iOCT-guided partial ILM peeling with inferior flap coverage is a feasible and safe surgical approach for IMH, with outcomes not statistically different from the standard ILM peeling technique. The novel technique may offer subtle benefits in preserving retinal structure and function, warranting further investigation.