Use of the Inverted ILM Flap Technique for Macular Hole Closure

The Inverted ILM (internal limiting membraneInternal Limiting Membrane (ILM)) Flap TechniqueFlap technique improved the closure rate not only of large full thickness macular holesMacular hole but also of macular holesMacular hole associated with different diseases, as pathological myopiaMyopia, age related macular degeneration, diabetic retinopathyDiabetic retinopathy and others. This novel surgical technique allows to eliminate type 2 closure (flat margins of the macular holeMacular hole, bare retinal pigment epithelium) from possible postoperative outcomes. Instead, some holes will be initially closed only with ILM (flap closure). Tissue regenerates with time and vision improves in this closure type. The only modification of the original Inverted ILM FlapInverted ILM Flap Technique with results confirmed in a randomized study is the Temporal Inverted ILM FlapInverted ILM Flap Technique. The technique consists of core vitrectomyVitrectomy, staining of the ILM with blue dyeBlue dyes, peeling of the ILM from the temporal side of the fovea only and positioning it on the top of the fovea in an inverted upside-down fashion. The vitreous cavity is filled with air at the end of surgery. It is extremely important not to introduce the ILM into the hole, but only to gently cover it, in order to maintain a good functional outcome. Visual acuity improvement was reported to be superior to cases where the ILM was peeled in all indications. The continuous improvement of vision lasts at least twelve months after surgery.