Introduction:

Idiopathic full thickness macular holes are foveal anatomic defects with interruption of all neurosensory retinal layers, resulting in visual and functional alterations with significant impact on the patient’s quality of life. Currently, the best therapeutic approach for macular holes is still being debated, after the new classification by the International Vitreomacular Study Group. Several surgical methods have been suggested towards a greater anatomic success, namely vitrectomy with complete peeling or with inverted or reverted flap of the internal limiting membrane (ILM). Some authors prefer to choose the last ones for bigger dimension holes. In unsuccessful cases, after having performed ILM peeling in previous surgery, several solutions were reported, namely the arched temporal incision, radial incisions, or the ILM graft.

Material & Methods:

In this study, the authors present 4 clinical cases and techniques used at the Ophthalmology Department of Setubal’s Hospital, for the closure of idiopathic macular holes: one case of idiopathic macular hole treated with 23g vitrectomy, ILM peeling and SF6 tamponade; one case of macular hole previously operated, unsuccessfully, by means of a 23g vitrectomy revision, ILM graft with the help of heavy liquid (perfluorocarbon) by using a “funny trick”, followed by SF6 tamponade; and two, out of six cases, successfully operated by using a variation of the inverted ILM flap technique. There were no intra or post-surgical complications.

Discussion & Conclusion:

The different techniques used on macular hole surgery lead further and further to both anatomic success and functional improvement. Nevertheless, not all surgical approaches are consensual among retina surgeons. One should also refer the difference between anatomic success and functional success, which depends on several factors, namely the existence of vitreomacular traction, durability and dimension of the macular hole. The authors present a different version of the inverted flap technique helped by the heavy liquid. The six cases operated by this technique obtained anatomic and functional success.

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David da Fonseca Martins