Macular Holes in Diabetic Patients Treated with Inverted ILM Flap



To present different characteristics of macular holes in diabetic patients with and without retinopathy. Additionally, to examine the results of vitrectomy with the inverted ILM flap technique.

Material and Methods:

Retrospective, observational study. We reviewed our database in order to select patients with diabetes and macular holes treated with the inverted ILM flap technique. Patients had a complete ophthalmic examination and spectral domain or swept source OCT before surgery and then at one week, one, three, six and twelve months after surgery. In cases without retinopathy and with nonproliferative retinopathy core vitrectomy and the inverted ILM flap technique was performed. In proliferative diabetic retinopathy, complex vitrectomy was performed, completed with the inverted ILM flap.


20 eyes of 18 patients with diabetes and full-thickness macular holes were included in the study. 15 eyes had no signs of diabetic retinopathy, one eye had nonproliferative diabetic retinopathy and four eyes had proliferative retinopathy. All macular holes were closed after first surgery. Mean visual acuity in eyes without retinopathy was 0.41 logMAR and in proliferative retinopathy was 1.22 logMAR. Final visual acuity was significantly higher in eyes without visible retinopathy (p=0.0004). In OCT, in eyes with proliferative diabetic retinopathy even if the macular hole was closed with the inverted ILM flap, we observed persistent presence of fluid under the fovea, which required several months to reabsorb. In one case despite closure of macular hole the fluid did not reabsorb in more than twelve months follow-up. The prolonged absorption of fluid was associated with multiple photoreceptor, external limiting membrane and retinal pigment epithelium defects shown in OCT.


The inverted ILM flap technique allows closure of all macular holes, including in severe proliferative retinopathy. In proliferative diabetic retinopathy, we might distinguish another type of macular hole formation, which is caused not only by traction but also insufficiency of retinal pigment epithelium and its poor ability to absorb subretinal fluid in the long term.

Jerzy Nawrocki


Jerzy Nawrocki
Lodz, Poland
Cell Phone: +48606379620