ArticleClinical ophthalmology (Auckland, N.Z.)2026
Simple Superior Inverted Flap Technique with Extended Internal Limiting Membrane Peeling for the Treatment of Large Macular Holes.
Article in Clinical ophthalmology (Auckland, N.Z.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: To evaluate the anatomical and functional outcomes of a simplified superior inverted internal limiting membrane (ILM) flap technique with extended ILM peeling for the surgical treatment of large idiopathic macular holes (iMH). Patients and Methods: This retrospective, non-randomized, interventional consecutive case series included 42 eyes of 40 patients with iMH. Patients were grouped according to the CLOSE study classification: Group 1: large holes (n=19, minimum linear diameter [MLD] >400 to ≤550 µm), Group 2: extra-large holes (n=18, MLD >550 to ≤800 µm), and Group 3: XXL holes (n=5, MLD >800 to ≤1000 µm). The mean follow-up time was 20.63 ± 18.32 months. The primary endpoint was MH closure rate. Secondary outcomes included closure type, changes in best-corrected visual acuity (BCVA), ellipsoid zone (EZ) defect, flap position, and surgical complications. Results: Anatomical type 1 closure was achieved in all 42 eyes (100%). The proportion of favorable U-shaped closure decreased significantly with increasing hole size (χ Conclusion: The described surgical technique, involving the combination of a superior inverted ILM flap with extended ILM peeling and minimal manipulation of the posterior pole is highly effective in achieving anatomical and functional success in large iMHs up to 1000 µm, with a favorable safety profile and consistent structural recovery.
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