Macular Hole Surgery With ILM Flap, Viscoelastic, and Air Tamponade Without Positioning

Purpose: To report the results of macular hole (MH) surgery performed using the viscoelastic-supported temporal inverted ILM flap technique with air tamponade alone, without gas endotamponade or postoperative head positioning. Methods: A temporal ILM flap was created in all patients and inverted over the MH with perfluorocarbon liquid (PFCL). After a fluid-air and PFCL-air exchange, a dispersive viscoelastic agent was injected over the inverted flap under air, covering an area of two-to-three-disc diameters. The sclerotomies were closed with the eye filled entirely with air, without any subsequent gas exchange. No head positioning was advised postoperatively. Data on preoperative MH size, best-corrected visual acuity (BCVA), MH closure rate, closure pattern, and postoperative complications were collected. Results: The study included 78 eyes of 71 patients. MH closure was achieved in all 78 eyes (100%) after a single surgical procedure. U-shaped closure occurred in 82.1%, V-shaped in 14.1%, and W-shaped in 3.8%. Significant BCVA improvement was observed (p<0.001), with no significant change in IOP (p=0.057). Conclusion: The viscoelastic-assisted temporal inverted ILM flap technique achieves successful MH closure using air as the sole tamponade agent, without gas endotamponade or postoperative head positioning, yielding favorable anatomical and functional outcomes with enhanced patient comfort.