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

This article aims to determine the efficacy of a modified technique by a positive rotational internal limiting membrane (ILM) covering for the treatment of large idiopathic macular holes (IMHs).

A prospective analysis was conducted on a cohort of 13 patients with large IMH (> 400 μm). The ILM was dissected in approximately one diameter width of the optic disc from the inferior and temporal sides. Subsequently, a pedicled ILM flap connected to the optic disc was grasped and peeled from the superior edge of the residual ILM with a width of at least 2 papilla diameters (PDs). The pedicled ILM flap was then directly rotated to cover the IMH in a positive way. Some peeled-off ILM samples were collected for scanning electron microscopy (SEM) examinations. During each follow-up, best-corrected visual acuity (BCVA), SD-OCT scans, and M-CHARTS were performed.

The study successfully detected IMH closure in all cases. The mean BCVA (logMAR) showed a decrease from 1.18 ± 0.209 to 0.58 ± 0.202 (p < 0.001). Postoperatively, there was a significant reduction in the diameter of the ellipsoid zone (EZ) and external limiting membrane (ELM) defects compared to preoperative values (p < 0.001). Additionally, the defect size decreased further at the 3-month follow-up compared to the 1-month follow-up. Both horizontal and vertical deformations postoperatively showed significant improvements (p = 0.001, p < 0.001). At the final follow-up, 7 eyes exhibited U-shaped closure while 6 eyes showed V-shaped closure.

This technique is an effective treatment for larger IMHs. This technique has the potential to improve vision outcomes. Trial Registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR2300068411.