OVD-assisted press injection in gasless surgery for sectorial inverted internal limiting membrane flap stabilization

To describe and evaluate an ophthalmic viscosurgical device (OVD)-assisted press injection technique for stabilizing a sectorial inverted internal limiting membrane (ILM) flap in full-thickness macular hole (MH) surgery without perfluorocarbon liquid or endotamponade.

Twenty-eight eyes (28 patients) with full-thickness MH underwent 27-gauge pars plana vitrectomy with a superior sectorial inverted ILM flap. An OVD was first placed over the MH before indocyanine green (ICG) staining to minimize direct dye exposure to the fovea. After ILM flap creation, gentle OVD press injection was performed to flatten and secure the inverted flap over the hole. Postoperative outcomes included best-corrected visual acuity (BCVA), macular hole closure on optical coherence tomography (OCT), and surgical complications.

All surgeries were completed successfully using the OVD-assisted press injection technique. Anatomical closure of the macular hole was achieved in all eyes (100%). OCT demonstrated stable ILM flap coverage throughout follow-up. Mean BCVA improved significantly from 0.92 ± 0.29 log MAR preoperatively to 0.60 ± 0.29 log MAR at 3 months postoperatively (P < 0.001). No retinal detachment, MH reopening, or clinical evidence of ICG-related toxicity occurred. Intraocular pressure remained stable; transient hypotony occurred in two eyes and resolved within 1 week.

OVD-assisted press injection provides reliable mechanical stabilization of the inverted flap and enables macular hole closure without the need for perfluorocarbon liquids or endotamponade.

Not applicable.