To peel, to keep or to flap? the role of internal limiting membrane in macular hole surgery

The Temporal Inverted ILM Flap Technique was previously confirmed in prospective randomized trial performed by our group to be non‐ inferior to the original Inverted ILM Flap technique in large, long‐ standing full thickness macular holes.

During surgery, after core vitrectomy and membrane blue staining a flap is created from the temporal side of the fovea and then inverted upside down in order to close the macular hole. The vitreous cavity is filled with air and patients are advised to keep prone positioning for 3 days.

The success rate of this surgery was estimated to be about 95% in large, long‐ standing macular holes. It was also published, that macular holes associated with high myopia with and without a retinal detachment, macular holes coexisting with diabetic retinopathy (non‐ proliferative and proliferative), age related macular degeneration (dry and neovascular) and other diseases might not only be closed, but also experience improvement of visual acuity. During the talk also repeated surgeries will be presented, those in which the Temporal Inverted ILM Flap Technique could be used, and those, which required modifications of this technique (autologous ILM transplantation, pedicle flap, amniotic membrane).

The Temporal Inverted ILM Flap Technique not only improved anatomical and functional outcome, but also eliminated type 2 closure (Flat open macular hole) from postoperative closure types. Eyes, which previously would close in this form, now develop the “flap closure”. In contrary to type 2 closure, they experience regeneration of foveal anatomy and improvement of visual acuity.