Conventional Internal Limiting Membrane Peeling Versus Temporal Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes: A Comparative Study

Purpose: To compare the anatomical, morphological, and functional outcomes of the conventional internal limiting membrane (ILM) peeling versus temporal inverted internal limiting membrane flap technique for large full-thickness macular holes (FTMHs). Subjects and Methods: Forty-six eyes of 44 patients with a minimum base diameter > 600 µm were included in this retrospective interventional study. The patients were divided into Group 1 (conventional ILM peeling) and Group 2 (temporal inverted ILM flap). The hole closure rate, best-corrected visual acuity (BCVA), ellipsoid zone (EZ), and external limiting membrane (ELM) defects were analyzed at baseline and 6 months after surgery.Results: Hole closure was achieved in 17/25 (68%) cases of Group 1 and 20/21 (95.2%) cases of Group 2. The hole closure rate was significantly higher in the temporal inverted ILM flap group (p = 0.022). The mean BCVA (logMAR) changed from 1.12 ± 0.43 to 0.72 ± 0.31 in Group 1 and from 1.07 ± 0.34 to 0.51 ± 0.26 in Group 2 at six months (p < 0.001 in both cases). U-shaped closure was observed in 3 (12%) eyes in Group 1 and 15 (71.4%) eyes in Group 2 (p < 0.001). The total restoration rates of ELM and EZ were significantly higher in the temporal inverted ILM flap group (p = 0.009, p = 0.001, respectively).Conclusion: The temporal inverted ILM flap technique is more effective than conventional ILM peeling for larger than 600 µm macular holes and improves anatomical, morphological, and functional outcomes.