Modification of the Temporal Inverted Internal Limiting Membrane Flap in Macular Hole Surgery: Envelope Technique

Area of Science:

• Ophthalmology
• Retinal Surgery
• Surgical Techniques

Background:

• The inverted internal limiting membrane (ILM) flap technique, introduced in 2010, offers improved outcomes for large macular holes compared to standard ILM peeling.
• Flap displacement remains a significant complication associated with the inverted ILM flap technique, potentially leading to surgical failure.

Purpose of the Study:

• To present a modification of the temporal inverted ILM flap technique for macular hole surgery.
• To address and mitigate the issue of flap displacement in inverted ILM flap procedures.
• To evaluate the efficacy of the modified technique in complex macular hole cases.

Main Methods:

• A case report detailing a modified inverted ILM flap technique termed the "envelope modification."
• In the first case, a displaced ILM flap was reinverted and stabilized by tucking its corner under a small ILM defect.
• The "envelope modification" was subsequently applied during silicone oil removal in a patient with rhegmatogenous retinal detachment and a macular hole.

Main Results:

• The modified technique successfully stabilized the ILM flap in both reported cases.
• Both patients experienced improved visual acuity following the surgical intervention.
• The "envelope modification" facilitated macular hole closure in a complex scenario involving silicone oil removal.

Conclusions:

• The "envelope modification" of the inverted ILM flap technique shows promise for improving success rates in macular hole surgery.
• This technique may offer a solution for managing flap displacement, a known complication of the inverted ILM flap procedure.
• Further investigation into this modification could enhance functional and anatomical outcomes in challenging macular hole cases.