The aim of this study is to present the comparative non-randomised study of Temporal Inverted Flap Technique vs. Classic ILM Flap Technique for Macular Hole Closure.


This is a single center, comparative study. 43 eyes of 39 patients mean age 67, were operated with classic ILM Flap technique (Group A) and 44 eyes of 40 patients, mean age 66, were operated on using only a temporal flap of ILM (Group B). In group B, ILM between the fovea and optic disc was not peeled. All of the eyes completed 12 months of post-operative follow up. Spectral Domain OCT was performed before and 1 week, 3, 6 and 12 months after surgery.


Mean pre-operative VA were 0.16 for Group A and 0.12 for Group B. There was no statistically significant difference between the groups for pre-operative macular hole size nor visual acuity. Final anatomical results were the same and mean functional results were 0.46 in Group A and 0.41 in Group B (p=0.7). In both groups we found that photoreceptor defects and external limiting membrane (ELM) defects decrease with time and retina nerve fiber layer defects increase with time. Regeneration of ELM is necessary for photoreceptor regeneration. The difference between Group A and Group B is that in Group B we observed retina nerve fiber layer (RNFL) defects less frequently and faster achievement of ‘good structural shape’ of the fovea. ‘U-shape’ closure was observed in 71% in Group B and 62% in Group A. RNFL defects were present in 84% of Group A and 64% in Group B. After 12 months, all macular holes were closed.


The Temporal Inverted ILM Flap Technique seems to be equally as effective as the original method with less damage to the RNFL. It allows us to achieve good anatomical and functional results.