Inverted Internal Limiting Membrane Technique for Macular Hole Retina Detachment



Inverted internal limiting membrane (ILM) flap technique has been shown to give superior anatomical closure results when compared to ILM peel techniques in large size macular holes and macular hole retina detachment cases in myopic eyes. In this video case the inverted internal limiting membrane technique is used to seal the macular hole in a case of large macular hole retina detachment.


A macular hole retina detachment in which the macular hole is the only retina break present is seen upon fundal examination in a 53 year old male who presented with a 2 week history of poor vision in the right eye. Visual acuity was CF at presentation and the IOP was 6mmHg in the right eye, left eye was 12mmHg. He had a RAPD in the right eye. He was phakic with some early cataract.


He had a macular hole with a total retina detachment, extending up to the periphery. A Fundus picture of the posterior pole as well as a B scan will be attached to the video showing the total RD. He had a 23G vitrectomy. PFCL was used to stabilize the retina while ILM (stained with duo Blue) was peeled around the macular hole. The video demonstrates the peeled ILM inverted into the macular hole under PFCL. The PFCL bubble was used to stabilize the retina during the peel; then rolled away to make room for the inversion of the ILM into the macular hole. A drainage retinotomy was performed in this case to drain the sub retina fluid. Silicon oil was used as tamponade. Post operatively his visual acuity improved with a well-reattached retina. Macular hole appears flat and closed. Postoperative OCT shows plug of ILM closing the macular hole. Silicone oil was successfully removed and the macular hole remained closed and retina attached.


Ogugua Okonkwo
Lagos, Nigeria
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