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Inverted ILM Drape Technique for the Management of Refractory Full Thickness Macular Hole
Purpose:
To describe and evaluate a modified inverted internal limiting membrane (ILM) flap technique for the management of a refractory full-thickness macular hole (FTMH).
Methods:
A 65-year-old female, after a failed pars plana vitrectomy (PPV) with ILM peeling and platelet-rich plasma (PRP) plugging, underwent reoperation for the persistent FTMH using the Inverted ILM Drape Technique. This approach involved extending the ILM peeling nasally and temporally, followed by the creation of large superior and inferior ILM flaps, which were inverted to cover the FTMH. The surgical outcomes were evaluated using spectral-domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA) assessments.
Results:
The FTMH was successfully closed following the Inverted ILM Drape Technique. BCVA improved significantly, from 20/100 after the first surgery to 20/30 after the second, representing a gain of about five ETDRS lines. SD-OCT confirmed FTMH closure at both the one-week and 45-day follow-up visits.
Conclusion:
Although limited to a single case, these findings suggest that the Inverted ILM Drape technique may represent a valuable option for refractory FTMHs, particularly when perifoveal ILM is no longer available.
