Positive Rotational Internal Limiting Membrane Covering Technique for Large Idiopathic Macular Holes

Area of Science:

• Ophthalmology
• Retinal Surgery
• Surgical Techniques

Background:

• Idiopathic macular holes (IMHs) are a significant cause of vision loss.
• Large IMHs (>400 μm) present a surgical challenge with often suboptimal visual outcomes.
• Existing surgical techniques for IMH closure have varying success rates, particularly for larger defects.

Purpose of the Study:

• To evaluate the efficacy of a novel modified technique using a positive rotational internal limiting membrane (ILM) flap for treating large IMHs.
• To assess the anatomical closure rates and visual acuity improvements following this surgical intervention.

Main Methods:

• A prospective study involving 13 patients with large IMHs (>400 μm).
• A pedicled ILM flap, dissected and rotated to cover the macular hole, was employed.
• Postoperative assessments included best-corrected visual acuity (BCVA), spectral domain optical coherence tomography (SD-OCT), and M-CHARTS.

Main Results:

• Successful closure of the IMH was achieved in all 13 patients.
• Mean BCVA significantly improved from 1.18 (logMAR) to 0.58 (logMAR) (p < 0.001).
• Significant reductions in ellipsoid zone (EZ) and external limiting membrane (ELM) defects were observed postoperatively, with further improvement at 3 months.

Conclusions:

• The modified positive rotational ILM flap technique is effective for treating large IMHs.
• This surgical approach demonstrates potential for substantial improvement in visual outcomes.
• The technique offers a viable option for managing challenging macular hole cases.