Anterior Capsular Flap Assisted Re-surgery for Persistent Full-Thickness Macular Hole

Describing the anatomical and functional outcomes of anterior capsular flap-assisted re-surgery for a persistent full-thickness macular hole following complete ILM removal.

A 58-year-old male with a persistent full-thickness macular hole after primary pars plana vitrectomy with ILM peeling underwent re-surgery using an autologous anterior lens capsular flap combined with phacoemulsification. The capsular flap was placed in an overlay configuration under partial fluid-air exchange without the use of perfluorocarbon liquid, autologous blood, or serum. Postoperative evaluation included serial UWFI and SD-OCT over an 11-month follow-up period.

Type 1 macular hole closure was achieved following re-surgery with autologous capsular transplantation. Serial OCT demonstrated progressive restoration of outer retinal layers, with reconstitution of the external limiting membrane followed by gradual ellipsoid zone recovery over time. The capsular flap showed stable integration with gradual thinning and shrinkage, without evidence of traction or pathological gliosis. Best-corrected visual acuity improved from 6/12 preoperatively to 6/8 at final follow-up.

Anterior capsular flap transplantation achieved stable macular hole closure with durable graft integration without the use of perfluorocarbon liquid or autologous blood, demonstrating that adjunct-free capsular scaffolding can provide long-term stability without displacement.