Aug 2026· European Eye Research· 0 citations· 26 references
TL;DR
The inverted ILM flap technique provides high anatomical closure rates and significant visual improvement in large MH surgery and Structural SS-OCT parameters can be clinically useful in predicting post-operative functional outcomes.
Abstract
Purpose: The purpose of the study was to evaluate the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique in patients with large macular holes (MHs) and identify independent prognostic factors that predict post-operative visual acuity. Methods: This retrospective study included 48 eyes of 48 patients who underwent pars plana vitrectomy and inverted ILM flap technique for idiopathic MHs ≥400 μm. Pre-operative and post-operative best-corrected visual acuity (BCVA), swept-source optical coherence tomography (SS-OCT) parameters, and various clinical factors were evaluated. Multivariate regression analysis was performed to identify independent prognostic factors for the post-operative BCVA. Results: The mean BCVA improved significantly from 1.27±0.41 logMAR preoperatively to 0.62±0.37 logMAR at 6 months postoperatively (p<0.001). U-shaped closure was associated with better BCVA than V-and W-shaped closures (p=0.001). Patients with symptom duration ≤6 months and complete post-operative restoration of the external limiting membrane (ELM) and ellipsoid zone demonstrated significantly better BCVA (p<0.01). Pre-operative BCVA (β=0.637, p<0.001) and MH index (MHI) (β=−0.261, p=0.029) were significant independent determinants of post-operative BCVA. Conclusion: The inverted ILM flap technique provides high anatomical closure rates and significant visual improvement in large MH surgery. Pre-operative BCVA and MHI were significant independent prognostic factors for post-operative visual outcomes. Structural SS-OCT parameters can be clinically useful in predicting post-operative functional outcomes
Larger hole dimensions were associated with poorer visual prognosis, whereas greater HH was associated with anatomical closure, and flap-assisted ILM techniques may improve anatomical success in TMH surgery.
S. Ozcalıskan, M. Ozbek, Anıl Korkmaz et al.· Journal of Clinical Medicine· 0 citations
To evaluate anatomical and functional outcomes after idiopathic full-thickness macular hole (FTMH) surgery and identify factors associated with anatomical closure and six-month visual outcome. This retrospective study included 74 eyes of 74 patients who underwent primary pars plana vitrectomy (PPV) between June 2014 and November 2025. Surgery was performed with either conventional internal limiting membrane (ILM) peeling or temporal inverted ILM flap surgery. Baseline clinical data, optical coherence tomography (OCT) parameters, including minimum linear diameter (MLD) and macular hole index (MHI), tamponade type, anatomical outcomes, reoperation status, and best-corrected visual acuity (BCVA) were analyzed. Primary anatomical closure was defined as closure after the initial surgery, whereas final anatomical closure was defined as closure at final follow-up, including closure after reoperation. An exploratory adjusted linear regression model evaluated factors associated with six-month BCVA. Primary anatomical closure was achieved in 59 eyes (79.7%), and final anatomical closure increased to 64 eyes (86.5%) after reoperation. Median BCVA improved from 1.30 to 0.70 logMAR at postoperative months 3 and 6 (both p < 0.001). Reoperation was performed in 9 eyes with persistent macular hole and achieved closure in 5 eyes (55.6%). Poorer preoperative BCVA was associated with persistent anatomical failure after primary surgery and at final follow-up (p = 0.021 and p = 0.023). Primary surgical technique, MLD category, and MHI category were not associated with anatomical closure. Although eyes treated with temporal inverted ILM flap surgery had poorer preoperative BCVA and a numerically larger MLD, six-month BCVA gain was greater in these eyes in the unadjusted comparison (p = 0.036). However, after adjustment for preoperative BCVA and MLD, surgical technique was not independently associated with six-month postoperative BCVA (p = 0.155). Better preoperative BCVA and smaller MLD were associated with better six-month postoperative BCVA (p = 0.001 and p = 0.021). Surgery achieved anatomical closure in most eyes and significant six-month visual improvement. Baseline visual acuity and MLD may be clinically relevant markers of postoperative outcome, whereas the apparent unadjusted visual benefit of temporal inverted ILM flap surgery should be interpreted cautiously.
In large macular holes, an extended ILM flap of approximately 1.5–3 DD improved anatomical stability and visual recovery, representing an effective surgical strategy, suggesting flap size modification may not be necessary for optimal results.
Na Gyung Kim, Myung In Yeom, Jung Min Park· Journal of the Korean Ophtha...· 0 citations
Postoperative restoration of the foveal pit is strongly associated with superior BCVA gain and CMT reduction, highlighting foveal morphology as a key prognostic marker for surgical success.
Aydın Maçin, Didem Serin· Zeynep Kamil Medical Journal· 0 citations
Lower CMT at 1 month after surgery is significantly associated with favorable visual outcomes at 6 months, suggesting its potential value as an early postoperative prognostic indicator, and the importance of incorporating early postoperative OCT assessment into clinical follow-up to facilitate individualized prognosis and patient counseling.
Full-thickness macular holes (FTMHs) larger than 400 μm remain a surgical challenge with suboptimal closure rates when treated with conventional internal limiting membrane (ILM) peeling. The temporal inverted ILM flap technique has emerged as a promising alternative, yet direct comparisons-particularly regarding hole size specific outcomes and outer retinal microstructural recovery-remain scarce. This study aimed to compare the functional, anatomical, and morphological outcomes of these two surgical approaches.
This retrospective study included 32 patients with large idiopathic FTMHs (> 400 μm) who underwent surgery between 2020 and 2024. Patients were divided into two groups: conventional ILM peeling (Group 1,
n
= 16) and temporal inverted ILM flap technique (Group 2,
n
= 16). All procedures were performed by a single experienced surgeon. Best-corrected visual acuity (BCVA), MH closure rate, closure configuration, diameter hole index (DHI), and outer retinal layer parameters including ellipsoid zone (EZ) and external limiting membrane (ELM) integrity were assessed using spectral-domain optical coherence tomography (SD-OCT) at baseline and 12 months postoperatively.
Baseline characteristics did not differ significantly between the groups (all
p
> 0.05). Both groups showed significant improvement in BCVA after surgery (both
p
< 0.05). At 12 months, postoperative BCVA was 0.71 ± 0.46 logMAR in Group 1 and 0.38 ± 0.32 logMAR in Group 2, with significantly better BCVA in Group 2 (
p
= 0.039). Primary closure was achieved in 75.0% (12/16) of eyes in Group 1 and 100% (16/16) in Group 2, although the overall difference was not statistically significant (
p
= 0.101). In an exploratory post hoc subgroup analysis of eyes with a minimum hole diameter ≥ 550 μm, primary closure occurred in 33.3% (2/6) of Group 1 eyes and 100% (8/8) of Group 2 eyes (
p
= 0.015); both groups achieved 100% closure in holes measuring 400–549 μm. Postoperative EZ defect size was 1028.62 ± 606.93 μm in Group 1 and 539.12 ± 618.09 μm in Group 2, with a significantly smaller defect size in Group 2 (
p
= 0.040).
In this retrospective, non-randomized cohort, the temporal inverted ILM flap technique was associated with better postoperative BCVA and a smaller postoperative EZ defect size than conventional ILM peeling. Although an exploratory post hoc subgroup analysis suggested a higher primary closure rate in Group 2 among eyes with a minimum hole diameter ≥ 550 μm, the overall closure-rate difference was not statistically significant, and the subgroup analysis was based on very small sample sizes. Further prospective studies with larger sample sizes are needed to confirm these findings.
Not applicable (retrospective study).
