Macular hole treated by the inverted internal limiting membrane flap technique: case report

Pars plana vitrectomy with peeling of the internal limiting membrane is a standard surgical procedure for an idiopathic macular hole. However, it may not always be associated with a favorable functional and anatomical outcome. Further, with gas tamponade face-down posturing 90 % of the time for at least a week is recommended, which causes the patient discomfort and increases the risk of cataracts.

A case of unilateral macular hole in a 74-year-old female patient with initial visual acuity of 0.3 treated by pars plana vitrectomy using an inverted membrane technique is presented. In this method, the internal limiting membrane is peeled off, but a remnant of the membrane attached to the margins of the macular hole is left in place. This membrane flap is then inverted upside-down to cover the macular hole. The facedown position was maintained only overnight.

Six days after surgery optical coherence tomography showed a closed macular hole with restoration of the foveal depression and an intact external limiting membrane. Visual acuity improved to 0.5.

To increase the percentage of final macular hole-closure it is important to search for new treatment options. An inverted flap technique may support the healing process at the macula and at the same time reduce the need for gas tamponade and postoperative positioning of the patient.