Efficacy of macular hole surgery with inverted internal limiting membrane flap technique and air tamponade

[Objective] To assess the efficacy of the inverted internal limiting membrane (ILM) flap technique with air tamponade for macular holes (MHs). [Methods] A retrospective analysis was conducted on 71 patients (71 eyes) who underwent inverted ILM flap surgery combined with air tamponade for macular holes at Zhongshan Ophthalmic Center from 2016 to 2019. Patients were positioned face down for 1-3 days postoperatively and followed up for more than 6 months. OCT was used to determine the closure rate of macular holes, and the best corrected visual acuity (BCVA) before and after surgery was compared. The MAIA microperimeter was used to assess the average macular sensitivity, macular integrity index, and fixation stability P1 and P2 before and after surgery. [Results] Of the total 71 eyes, 91.5% achieved complete MH closure. The best corrected visual acuity (BCVA) significantly improved before and after surgery (P<0.001), average macular sensitivity significantly increased (P<0.000 1), macular integrity index significantly decreased (P<0.000 1),and fixation stability P1 (P<0.000 1) and P2 (P<0.001) both significantly improved. [Conclusions] Inverted ILM flap technique combined with air tamponade provides an effective approach for the management of MHs. The air tamponade should be considered as the preferred in MH surgeries, reducing the discomfort caused by prolonged face-down positioning. Parameters in microperimetry can serve as good indicators for assessing the recovery of macular structure and function.