Inverted internal limiting membrane flap technique for full-thickness macular holes in Black Africans

To report the outcomes of inverted internal limiting membrane (ILM) flap 'flower-petal' surgical technique for the treatment of full-thickness macular hole (FTMH) in patients from Rwanda.

This is a retrospective consecutive case series of all cases of FTMH that underwent pars plana vitrectomy (PPV) surgery with inverted ILM flap technique between April 2022 and March 2023 at the Kabgayi Eye Unit. The primary outcome was the anatomical success defined as FTMH closure. The secondary outcome was the change in best-corrected visual acuity (BCVA) before surgery and at final visit, termed as ΔBCVA.

A total of ninety-eight eyes of ninety-eight patients (65% females) were included in the analysis. Mean patient age was 61.3 ± 15.7 years (range 7-82). Mean follow-up duration was 8.9 ± 4.2 months (range 2-15). Mean minimum linear diameter (MLD) was 549 ± 315 µm (range 50-2150). Postoperative macular hole closure rate was 93%. Mean BCVA improved from 1.24 ± 0.37 logMAR (range 0.4-2) to 0.95 ± 0.50 logMAR (range 0-3; p-value < 0.001). Most patients (56%) underwent PPV only, while in the remainder PPV was combined with phacoemulsification cataract surgery. SF6 gas was the most commonly used postoperative tamponade (37%), followed by C3F8 (36%) and C2F6 (27%). Postoperative complications were encountered in 6 cases (6%), the most common being eccentric macular holes (5%).

The inverted ILM flap technique for FTMH in a Black African population demonstrated a high anatomical success rate. Our results will guide future management practices for the Black African ethnicity where FTMH outcomes are notoriously worse.