Inverted Internal Limiting Membrane Flap vs Complete Internal Limiting Membrane Peeling for Large Macular Holes in Nonposturing Surgery

Abstract

Purpose: This study compared anatomical and functional outcomes of the inverted internal limiting membrane flap (ILMF) technique with complete ILM peeling (ILMP) in nonposturing surgery for large, full-thickness macular holes (MHs). Methods: This was a retrospective, comparative, single-surgeon study. Eyes with idiopathic large full-thickness MHs (minimum diameter > 400 μm) were included. A total of 46 patients including 22 ILMF cases and 24 ILMP cases were analyzed. No positioning instructions were advised postoperatively. Results: Primary hole closure was achieved in all patients (100%) in both groups. Mean logMAR visual acuity (VA) improved significantly in both groups compared with the preoperative values (ILMF: 0.60 [SD, 0.26] postoperatively, vs 0.93 [SD, 0.3] preoperatively, P = .032; ILMP: 0.43 [SD, 0.22] postoperatively vs 0.83 [SD, 0.16] preoperatively, P < .01). However, ILMP showed a statistically significant improvement in VA compared with ILMF ( P = .02). Conclusions: All MHs in both groups closed after surgery (100%). There was a statistically significant improvement of VA in the ILMP group compared with the ILMF group ( P = .02). Not posturing after surgery did not compromise surgical success in both groups.