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A Comparative Study

Michalewska, Zofia MD, PhD*; Michalewski, Janusz MD, PhD*; Dulczewska-Cichecka, Karolina MD*; Adelman, Ron A. MD, MPH; Nawrocki, Jerzy MD, PhD*

doi: 10.1097/IAE.0000000000000555
Original Study

Purpose: To determine if reducing the area of internal limiting membrane (ILM) peeling in the inverted ILM flap technique results in satisfactory outcomes for the repair of large Stage IV idiopathic macular holes.

Methods: Prospective comparative interventional study of 87 consecutive eyes. Participants were randomized into two treatment groups. In Group A, the classic inverted ILM flap technique was performed. In Group B, a modification of this procedure, the temporal inverted ILM flap technique, was performed. In the modified inverted ILM flap technique, peeling of the ILM was restricted to the temporal side of the fovea only—the macular hole was then covered with the temporal ILM flap.

Results: There was no significant difference in initial and final visual acuities between Groups A and B. In both groups, defects in photoreceptors and the external limiting membrane decreased with time. Successive postoperative examinations revealed an increasing number of patients with the dissociated optic nerve fiber layer appearance, although this was less frequent in Group B (modified ILM flap) than in Group A.

Conclusion: The study results indicate that the temporal inverted ILM flap technique is as effective as the classic inverted ILM flap technique for the repair of large Stage IV macular holes.

Temporal inverted internal limiting membrane flap technique for large macular holes enables achieving similar results as in the inverted internal limiting membrane flap technique. Additionally, temporal inverted internal limiting membrane technique tends to cause less retinal nerve fiber layer defects.

*Ophthalmic Clinic “Jasne Blonia”, Lodz, Poland; and

Ophthalmic Department, Yale University School of Medicine, New Haven, Connecticut.

Reprint requests: Zofia Michalewska, MD, PhD, Klinika Okulistyczna “Jasne Blonia,” Rojna 90, Lodz 91-162, Poland; e-mail:

Presented at Vail Vitrectomy Meeting 2013, European VitreoRetinal Society (EVRS) Annual Meeting 2014, American Society of Retina Specialists (ASRS) 2014, World Ophthalmology Congress 2014, and American Academy of Ophthalmology (AAO) 2014.

None of the authors have any financial/conflicting interests to disclose.

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© 2015 by Ophthalmic Communications Society, Inc.