Tamponade-free superior ILM flap for idiopathic macular hole repair: a pilot study

To report the feasibility, anatomical closure, and visual outcomes after a tamponade-free, perfluorocarbon liquid (PFCL)-free, viscoelastic-assisted superior internal limiting membrane (ILM) flap technique for idiopathic full-thickness macular holes (FTMH).

Prospective, non-comparative pilot study of consecutive adults with idiopathic FTMH undergoing 25-gauge pars plana vitrectomy, superior ILM flap creation and intraoperative stabilization with dispersive viscoelastic. No PFCL, gas, or air tamponade was used, and no face-down positioning was required. Minimum follow-up was 3 months.

Twenty-six patients, fifteen women (57.7%) and eleven men (42.3%) were included in the study. The mean age was 72.2 ± 8.5 years (range 51-88). Mean minimum linear diameter (MLD) was 341.2 ± 191.8 μm (range 50-775 μm); 9 holes were small (< 250 μm), 10 were medium (250-400 μm), and 7 were large (> 400 μm). The mean duration of symptoms was 4.85 ± 3.34 months. Primary anatomical closure after one procedure occurred in 25/26 cases (96.2% primary success). The mean follow-up was 4.77 ± 1.37 months. Best-corrected visual acuity improved significantly (from 1.12 logMAR, to 0.46 logMAR, p < 0.001). Two intraoperative retinal tears occurred during posterior vitreous detachment (PVD) induction and were treated with endolaser; no postoperative retinal detachment, hypotony, or endophthalmitis occurred.

In this prospective pilot series, a PFCL-free, tamponade/air-free, viscoelastic-assisted superior ILM flap technique was associated with a high primary closure rate without postoperative positioning. Larger comparative studies with longer follow-up are needed to assess generalizability and complication rates, particularly for large macular holes.