Comparison of Outcomes Between the Classical and Superior Inverted ILM Flap Techniques in Idiopathic Large Macular Hole Surgery.

Objective: This study aimed to examine the anatomical and visual outcomes of surgical management for large idiopathic macular holes (MH), comparing the classical inverted internal limiting membrane (ILM) flap covering approach with the superior inverted ILM flap method.

Methods: A total of 47 eyes with large idiopathic MHs were retrospectively reviewed; all underwent surgical intervention between July 2021 and March 2024. Patients undergoing the classical inverted ILM flap covering technique were categorized as Group 1 (n=22), while those treated using the superior inverted ILM flap method were included in Group 2 (n=25). The assessed outcomes were best corrected visual acuity (BCVA), closure status of the MH, foveal configuration (U-, V-, or W-type), and restoration of the ellipsoid zone (EZ) and external limiting membrane (ELM), assessed at baseline and at 1, 3, and 6 months following surgery.

Results: No significant variations were observed in baseline characteristics between the two groups. Primary closure rates were 95% and 96%, with all eyes achieving final closure. No significant differences were found in foveal closure types, EZ/ELM restoration, or BCVA at any postoperative time point (p > 0.05). Both techniques resulted in comparable anatomical and visual outcomes.

Conclusions: Both classical and superior inverted ILM flap techniques demonstrated favorable anatomical and visual outcomes in the repair of large idiopathic MHs. The superior inverted technique may be advantageous for patients unable to maintain prone positioning.