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A New Complementary Touch for the Temporal Inverted Internal Limiting Membrane Flap Technique.

Levent Karabas¹, Ecem Önder Tokuç¹, Sevim Ayça Seyyar²

¹Department of Ophthalmology, School of Medicine, Kocaeli University, Kocaeli, Turkey.

Journal of Ophthalmic & Vision Research

|July 21, 2025

Summary

A novel origami-like fold secures the internal limiting membrane (ILM) flap during macular hole (MH) surgery. This technique prevents flap displacement, improving outcomes in vitreoretinal surgery for large macular holes.

Keywords:

Vitrectomy Inverted Internal Limiting Membrane Flap Technique Macular Hole

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Area of Science:

Ophthalmology
Vitreoretinal Surgery

Background:

The temporal inverted internal limiting membrane (ILM) flap technique is used for large macular holes (MH).
A major challenge is the displacement of the ILM flap due to fluid leakage, compromising surgical outcomes.

Purpose of the Study:

To describe a modified temporal inverted ILM flap technique that enhances flap stability during macular hole surgery.

Main Methods:

A new approach involves creating an origami-like fold mark on the ILM flap using closed ILM forceps.
Gentle pressure is applied over the folded edge to create a stable crease before inverting the flap over the macular hole.

Main Results:

The created fold mark provides stability to the ILM flap.
This technique prevents flap displacement caused by minimal fluid leakage into the posterior pole.

Conclusions:

The modified temporal inverted ILM flap technique with an origami-like fold offers improved stability.
This method addresses the concern of ILM flap displacement, potentially leading to better surgical results for large macular holes.