Inverted Internal Limiting Membrane Flap Technique



To describe inverted ILM flap technique, a modification of the standard macular hole surgery technique and to investigate the impact of different parameters such as presenting vision, stage/size of the hole and duration of symptoms in the success of the surgery.


A standard 3-port, 23-gauge transconjunctival pars plana vitrectomy was performed under local anesthesia. After removal of all vitreous cortex, posterior hyaloid was removed by active suction using a vitreous cutter. ILM was then stained by membrane dual (BBG) for 45 sec. Initial ILM peeling, starting 1000 μm from the edge of the hole was performed to make a flap away from the central fovea in one quadrant using a microforceps. ILM was then peeled in a curvilinear manner centered around the site that was away from the central fovea up to the margins of the macular hole. The edge of the residual ILM at the central fovea was trimmed by a vitreous cutter to preserve epi-foveal ILM of about 500 μm. Then the remaining ILM is put on the surface of the macular hole in an inverted memo, this means that the primarily retinal part is oriented to the vitreous cavity and the vitreous part to the retinal pigmented epithelium. The flap can be pushed into the hole to fill it instead to cover it. A gas tamponade was used in all eyes. The main outcome measures were OCT findings and the best-corrected visual acuity (BCVA). All patients were followed up for more than 12 months.


The inverted ILM flap technique improves both the functional and anatomic outcomes of vitrectomy for macular holes with a diameter greater than 400micron compared with the standard surgery.


Roberta Giannini
Rome, Italy
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