Inverted internal limiting membrane flap technique versus internal limiting membrane removal in large macular hole with different hole edge configurations: a comparative study

Purpose: To compare the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique and the complete ILM removal in the treatment of large macular hole (MH) > 400 μm with or without Hole-door structures. Methods: This retrospective study analyzed 56 patients with MH > 400 μm. Based on hole edge morphology evaluated by archived intraoperative optical coherence tomography (iOCT) images, patients were divided into the Hole-door group (Group 1) and the Negative group (Group 2). Within each group, patients were further classified into two subgroups based on the surgical technique performed: complete ILM removal (Group 1-a, 2-a) and visco-assisted ILM flap (Group 1-b, 2-b). External limiting membrane (ELM) and ellipsoid zone (EZ) restoration and best-corrected visual acuity (BCVA) were assessed at 3 and 6 months post-surgery. Results: <0.05) Furthermore, functional and anatomical outcomes at 3 months showed significant correlation with the 6-month results, despite the ongoing microstructural improvements identified between these two time points. Conclusion: Large macular holes with Hole-door structures have a better prognosis than those without. In these cases, BCVA and retinal microstructure restoration are similar between ILM removal and ILM flap surgery, but the ILM flap accelerates recovery.