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Purpose: To evaluate the surgical management, outcomes and prognostic factors of full thickness macular holes without residual internal limiting membrane (NO-ILM FTMHs)., Methods: We performed a multicenter, retrospective study of 116 NO-ILM FTMHs. Human amniotic membrane (hAM) plug, autologous ILM free flap transplantation (AILMT), and autologous retinal graft transplantation (ART) were performed in 58, 48, and 10 patients, respectively. Data were collected before and up to 12 months after surgery. The primary outcomes were hole closure and final best-corrected visual acuity (BCVA)., Results: The final BCVA (0.78 ± 0.51 logMAR) was significantly better than and correlated with the initial BCVA (p < 0.0001 and p = 0.004, respectively). Hole closure was achieved in 92% of eyes. The minimum FTMH diameter was wider and final BCVA was lower in the ART group than in the other groups (p < 0.003 and p < 0.001, respectively). FTMHs with diameter > 680 μm had a higher closure rate with hAM than with AILMT (p = 0.02)., Conclusions: AILMT and hAM were the most frequently performed surgeries with both high closure rate and significant functional improvement. Preoperative BCVA was correlated with final BCVA. The minimum FTMH diameter may guide the treatment choice., (© 2022. The Author(s).)

Purpose: To report a case of large full thickness macular hole (MH) as an uncommon complication of an idiopathic retinal vasoproliferative tumor (RPVT) and the successful closure of the full-thickness MH by the inverted internal limiting membrane Flap technique., Methods: A case report. A 40-year-old woman was referred for a progressive and profound visual loss on the right eye. The fundus examination showed a full-thickness MH and the presence of an idiopathic RPVT surrounding by numerous exudates in the inferior temporal of the peripheral retina. In addition, the spectral domain optical coherence tomography imaging confirmed the large size of the full-thickness MH (740 μ m-diameter). First, we treated the RPVT using the transconjunctival cryotherapy. Then, we performed the macular surgery including 25 Gauge vitrectomy, inverted internal limiting membrane flap technique, and gas tamponade., Results: In the postoperative period, the RPVT remained inactive with no recurrence of the MH or excessive gliosis proliferation on the internal limiting membrane flap area. Moreover, visual acuity rose up from 20/100 (0.2) at 1-month follow-up to 20/40 (0.5) at 6-month follow-up., Conclusion: In our patient, the full-thickness MH was precisely large and secondary to an RPVT. The treatment of the tumor by transconjunctival cryotherapy had been efficient and the postoperative follow-up after the macular procedure involving the inverted internal limiting membrane flap technique showed the anatomical and functional recovery of the macula.

Background: To compare the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique and the complete ILM removal in the treatment of large stage 4 macular hole (MH) > 400 μm and to evaluate reconstructive anatomical changes in foveal microstructure using spectral-domain optical coherence tomography., Methods: This is a retrospective, consecutive, nonrandomized comparative study of patients affected by idiopathic, myopic or traumatic stage 4 MH (minimum diameter > 400 μm) treated with 25-gauge pars-plana vitrectomy with either complete ILM peeling (n = 23, Group 1) or inverted ILM flap technique (n = 23, Group 2), between August 2016 and August 2018. Main outcomes measured were the MH closure rate assessed by spectral-domain optical coherence tomography and the best-corrected visual acuity (BCVA) at six months. Foveal microstructure reconstructive changes were evaluated using SD-OCT to determine predictive factors of postoperative BCVA., Results: Closure of MH was achieved in 16/23 cases of Group 1 (70%) and in 22/23 cases of the Group 2 (96%). Surgical failure was reported in 6 cases of Group 1 and 1 case of Group 2. The MH closure rate was significantly higher with the inverted ILM flap technique (P-value = 0.02). Average BCVA (LogMAR) changed from 1.04 ± 0.32 to 0.70 ± 0.31 in Group 1 and from 0.98 ± 0.22 to 0.45 ± 0.25 in Group 2 (P-value = 0.005) at 6 months. Improvement in BCVA (> 0.3 LogMAR units) was statistically higher in the Group 2 (P-value = 0.03). Restoration of foveal microstructure was significantly higher in the Group 2 at 6 months (52% vs 9%, P-value < 0.01). In Group 2, the integrity of the external limiting membrane at 3 months postoperatively was the only significant feature correlated with postoperative BCVA at 6 months (r = 0.562; P-Value = 0.01, forward stepwise regression analysis)., Conclusion: Inverted ILM flap technique is more effective than the classic ILM peeling for the closure of large stage 4 MHs > 400 μm, improving both anatomical and functional outcomes. Early recovery of the external limiting membrane at 3 months is a positive predictive value of postoperative BCVA 6 months after inverted ILM flap technique.