To present a new surgical technique, in which Internal Limiting membrane (ILM) is not removed only in the papillomacular bundle during vitrectomy for macular hole.


This is a prospective study of 80 eyes of 80 patients. 40 eyes with macular holes were operated with the Inverted ILM technique (Group 1). 40 eyes were operated with modification of this technique, in which ILM was removed only on the temporal side of the macular hole and Inverted ILM flap was used to cover the macular hole (Group 2). Other elements of surgery were identical in both groups (core vitrectomy, posterior hyaloid detachment, staining with trypan blue, fluid/air exchange). All patients were operated between 01.2011 and 06.2012. Patients were controlled 1 week, 3 months, 6 months and 12 months after surgery. SD-OCT was performed at each visit

Effectiveness / Safety:

Mean preoperative minimal diameter of macular hole was 440 µm in Group 1 and 455 µm in Group 2. Base diameter was 873µm and 924µm respectively. Macular hole closure was obtained in 38/40 (95%) cases in Group 1 and in 37/40 (92.5%)in Group 2 after one surgery. Preoperative visual acuity was 0.92 LogMAR and (0.12 Snellen lines) in Group 1 and 0.82 LogMAR (0.15 Snellen lines) in Group 2. There were no statistical significant differences in both preoperative size of macular hole and visual acuity. Mean post-operative visual acuity after 12 months improved to 0.42 LogMAR (0.38 Snellen) in Group 1 and 0.33 LogMAR (0.46 Snellen) in Group 2. There were no statistically significant differences found between both groups both in anatomical closure rate and visual acuity at each visit.


Temporal Inverted ILM flap technique seems to be equally as effective as the original technique. Sparing removal of the ILM in the papillomacular bundle is possible without a negative influence on the results.