Modified internal limiting membrane flap technique for large chronic macular hole: Two case reports

Area of Science:

• Ophthalmology
• Retinal Surgery
• Macular Hole Treatment

Background:

• Standard treatments for macular holes (MHs) like internal limiting membrane (ILM) peeling and gas tamponade have limited success rates for large, chronic MHs.
• Modifications of ILM flap techniques are being explored to improve surgical outcomes for these challenging cases.

Observation:

• Two patients presented with large, chronic macular holes (MHs) diagnosed via optical coherence tomography (OCT), with minimum diameters exceeding 700 μm and significant duration.
• One patient had a 742 μm minimum diameter MH and 1630 μm base diameter, while the other had a 713 μm minimum diameter MH and 939 μm base diameter.

Findings:

• Both patients underwent successful treatment using the novel "Sandwich-type" modified ILM flap covering technique.
• Postoperative spectral-domain optical coherence tomography (SD-OCT) confirmed closure of the large, chronic MHs.
• Best-corrected visual acuity (BCVA) improved significantly in both patients, leading to high satisfaction.

Implications:

• The "Sandwich-type" modified ILM flap covering technique demonstrates potential as a safe and effective surgical option for managing large, chronic macular holes.
• This technique may offer improved visual outcomes compared to traditional methods for complex MH cases.