Autologous Free Internal Limiting Membrane Flap as Treatment of a Recurrent Macular Hole by Maria del Mar Prieto del Cura, Muxima Acebes Garcia, Maria Jose Crespo Carballes, Spain



Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, and gas tamponade has been the standard technique for large full-thickness macular holes (MH). Despite significant improvement in closure rates of idiopathic MH, those associated with retinal detachment (RD), myopic foveoschisis, trauma, and recurrent or chronic MH fail to close with this technique. In such eyes, the MH reopening rates are higher. We suggested that a technique for harvesting and repositioning an autologous free ILM flap can be a good option in chronic and recurrent MH fail to close with the conventional inverted ILM flap technique.

Case Report:

We present a case of recurrent MH with a full-thickness defect >500 μm after two VPP showing a reopened macular hole (MH) after an inverted ILM flap technique that did not maintain prone positioning postoperatively, following a prior pars plana vitrectomy for repair of a rhegmatogenous retinal detachment in a 45-year-old female. The patient underwent a repeat 23g PPV, after staining with membrane blue-dual® solution to identify the area of previous ILM peeled, harvesting from the inferior border a continuous curvilinear capsulorhexis of ILM was peeled to create an autologous free ILM flap larger than the diameter of the MH. The infusion line was turned off and the free flap was placed inside the MH. A low molecular weight viscoelastic material was placed over the free ILM flap to stabilize it. Immediately after reopening the infusion line, air-fluid exchange was performed with silicone oil (1000 centistokes) tamponade followed by 1 week of face-down position. One week postoperatively, the OCT radial scan showed closure of the MH and vision improved from logMAR (logarithm of the minimum angle of resolution) 1.3 to 0.8 one month post-surgery.


The presence of an open MH after a PPV technique with MLI peeling leaves few options for the vitreoretinal surgeon. Newer surgical technique as autologous ILM flap expand the surgeon’s armamentarium in tackling challenging cases of recurrent MH that have traditionally been reported poor anatomical and visual outcomes.



Maria del Mar Prieto del Cura, Muxima Acebes Garcia, Maria Jose Crespo Carballes
University Hospital Infanta Leonor
Email :
Cell Phone: +34680847460
Work Phone: +34680847460