Functional and morphological outcomes of the inverted internal limiting membrane flap technique in small and medium sized macular holes <400µm.

PURPOSE To assess the effect of an internal limiting membrane (ILM) flap (IF) in MH surgery on best-corrected visual acuity (BCVA) and integrity of the ellipsoid zone (EZ) and external limiting membrane (ELM). METHODS Patients were included who had successful surgery for MH <400µm with or without an IF. Main outcome measures were BCVA and restoration of the ELM and EZ at 12 months. RESULTS 60 patients were included, 36 with conventional peeling and 24 with an IF. BCVA improved from 0.74 (±0.30) logMAR (20/110 Snellen) to 0.26 (±0.20) (20/36 Snellen) in patients without and from 0.77 (±0.32) logMAR (20/118 Snellen) to 0.18 (±0.12) (20/30 Snellen) in patients with an IF, respectively. There was no difference in the integrity of the EZ and ELM in patients with or without an IF at either 3 (p=0.58, p=0.20), 6 (p=0.81, p=0.10) or 12 months (p=0.60, p=0.20) or in BCVA at 3 (p=0.24), 6 (p=0.18) and 12 months (p=0.11). In the multivariable model, only pre-operative BCVA (p<0.01), EZ integrity (p=0.001) and age (p<0.01) were associated with post-operative BCVA. CONCLUSIONS In patients undergoing surgery for MH <400µm the use of an IF did not affect BCVA or the integrity of the EZ and ELM.