It is challenging to achieve hole closure in chronic large macular holes or highly myopic eyes. Recently, various surgical techniques have been introduced using the ILM, and we also reported a technique to cover a macular hole with a Internal Limiting Membrane (ILM) inverted flap as a single layer using Perfluoro-n-octane(PFO). However, these procedures are not feasible f or recurrent macular hole that the ILM around the macular hole has been already removed. We developed a modified technique for covering a recurrent macular hole with a free flap of the ILM. After staining the residual ILM using brillant blue G, a small amount of PFO is injected over the optic disc. An ILM flap is harvested from the residual ILM and placed over macular hole. The flap is kept at the position by pressing with the closed intraocular forceps. As soon as the forceps was removed from the flap, the eyeball was rotated inferiorly to roll the PFO bubble onto the ILM flap. After confirming the proper position of the flap, about 0.5ml of PFO was injected further. Fluid-air exchange was performed and air was flushed gently for 3 minutes to evaporate the PFO. Vitreous cavity was tamponaded using a room air in macular hole cases and silicone oil in case of macular hole retinal detachment. Patients were instructed to have a face-down position as soon as possible after the s urgery. The position was kept for one day. We performed this technique in 3 eyes of 3 consecutive patients, two cases of macular hole and 1 case of macular hole with retinal detachment. In three cases, macular hole was closed successfully without a operation-related complication. This new technique would be useful for macular hole in various conditions that the ILM has been removed in the previous surgery such as epiretinal membrane, diabetic macular edema, macroaneurysm, as well as recurrent macular hole.

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