INTERNAL LIMITING MEMBRANE FLAP REPOSITION FACILITATES PRESERVATION OF THE INNER RETINA IN SURGICALLY CLOSED FULL-THICKNESS MACULAR HOLES

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PURPOSE: To compare inner retinal thinning after an internal limiting membrane (ILM) flap reposition technique with ILM peeling in full-thickness macular holes. METHODS: This retrospective study included a total of 78 eyes (75 consecutive patients) with primary full-thickness macular holes undergoing vitrectomy between October 2022 and December 2023. Exclusion criteria were secondary macular holes, high myopia, glaucoma, and prior surgery except cataract surgery. Eyes were separated by surgical technique into Group A (ILM flap repositioning; n = 30) and Group B (ILM peeling alone; n = 48). We compared mean thickness/volume of parafoveal (3 mm) and perifoveal (6 mm Early Treatment Diabetic Retinopathy Study subfields) retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer at 6 months after surgery (M6) to baseline (M0). Secondary, we assessed anatomical closure rate and visual acuity. RESULTS: Anatomical Type 1 closure was achieved in 90.00% (A) and 80.00% (B) without significant difference. For consistency in the subsequent analysis, only cases with successful closure were included. Preservation analysis at M6 showed thicker ( P = 0.006) and with more volume ( P = 0.010) in parafoveal retinal nerve fiber layer in Group A, whereas perifoveal ganglion cell layer remained thicker ( P = 0.001) and with more volume ( P = 0.002) in Group A. Inner plexiform layer did not differ between the groups. Visual acuity improved by time ( P < 0.001) without differing between the groups. CONCLUSION: Compared with ILM peeling, macular hole treatment with ILM flap repositioning results in better preserved retinal nerve fiber layer and ganglion cell layer, while maintaining a high closure rate and similar postoperative visual acuity.

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