Secondary Logo

Journal Logo

Institutional members access full text with Ovid®


Lee, Suhwan MD; Kim, June-Gone MD

doi: 10.1097/IAE.0000000000002132
Original Study

Purpose: To investigate the impact of preserving the foveal flap on surgical outcomes of full-thickness macular hole (MH) with foveal flaps.

Methods: We retrospectively reviewed patients with Stages 2 and 3 idiopathic MH, who underwent pars plana vitrectomy by a single surgeon at Asan Medical Center from November 2011 to November 2016. In the study group, we included eyes with MH and a foveal flap on preoperative spectral domain optical coherence tomography and successfully preserved the flap during surgery. The control group included eyes with MH and an operculum in the posterior vitreous plane on preoperative optical coherence tomography. We compared the anatomical and functional surgical outcomes between these groups.

Results: Postoperative mean best-corrected visual acuity at the last visit was 20/25 and 20/33 in the study (9 eyes) and control (23 eyes) groups, respectively. The study group showed a significantly better postoperative best-corrected visual acuity (P < 0.05). Restoration of both the external limiting membrane and ellipsoid zone, as assessed by spectral domain optical coherence tomography, was achieved in 9 (100%) and 15 (65.2%) eyes of the study and control groups, respectively.

Conclusion: Preserving the foveal flap might improve both functional and anatomical outcomes of vitrectomy for MHs with a foveal flap.

Preservation of flaps during vitrectomy in cases of macular hole with a foveal flap might significantly affect functional and anatomical outcomes of surgery. Thus, a saved flap technique with careful induction of posterior vitreous detachment and internal limiting membrane peeling may be used to maintain foveal flaps.

Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Reprint requests: June-Gone Kim, MD, Department of Ophthalmology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; e-mail:

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

© 2019 by Ophthalmic Communications Society, Inc.