To present a modification of the conventional inverted flap technique in stage IV macular hole surgery.


After a core vitrectomy and trypan blue-assisted ILM peeling. Two vertical tears were created, temporal and nasal, to the fovea. Boht flaps were folded over the fovea creating a large ILM peeling. Air fluid exchange was followed by SF6 25% injection.


Six eyes of 6 patients were treated with this technique and followed for 6 months. At the end of the follow-up 5 patients showed the macular hole closure. Preoperative visual acuity ranged from counting fingers (CF) to 20/100. Final visual acuity ranged from CF to 20/30 (mean 20/50). OCT disclosed the following events: 1- cyst disappearance were the first sign of surgical success; 2- hole clossure started beneath the ILM; 3- external retinal restoration was the last event during closure.


Double inverted ILM flap could be a reliable surgical technique for the treatment of stage IV macular hole surgery.

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Alejandro Lavaque