Foveal Microstructure in Macular Holes Surgically Closed by Inverted Internal Limiting Membrane Flap Technique

In Brief Purpose: To evaluate reconstructive foveal anatomical change in surgically closed macular hole (MH) by pars plana vitrectomy with inverted internal limiting membrane flap technique. Methods: Spectral domain optical coherence tomography was used to evaluate foveal microstructures in 20 eyes of 19 patients who underwent pars plana vitrectomy with inverted internal limiting membrane flap technique to achieve MH closure. Eyes had idiopathic large MH with a diameter >500 μm (n = 7), MH in high myopia (axial length >26.5 mm) without retinal detachment (RD; n = 7), and with RD caused by the MH (n = 6). Results: The 6-month postoperative spectral domain optical coherence tomography examination revealed restoration of the inner segment and outer segment junction in 3 of 7 idiopathic large MH eyes (43%), 2 of 7 highly myopic MH eyes without RD (29%), and 1 of 6 highly myopic MH eyes with RD (17%), and detected the external limiting membrane in 4 of 7 idiopathic large MH eyes (57%), 3 of 7 highly myopic MH eyes without RD (43%), 1 of 6 highly myopic MH eyes with RD (17%). Conclusion: Inverted internal limiting membrane flap technique results in more satisfactory anatomical improvements in patients with idiopathic large MH eyes and highly myopic MH eyes without RD than with highly myopic MH eyes with RD. This might suggest that the foveal photoreceptor layer in MH with RD is destroyed and not recoverable even after retinal reattachment with surgical closure of the MH. This study evaluated foveal microstructure in macular hole surgically closed by inverted internal limiting membrane flap technique using spectral domain optical coherence tomography. Inverted internal limiting membrane flap technique results in more satisfactory anatomical improvements in patients with idiopathic large macular hole eyes and highly myopic macular hole eyes without retinal detachment than with highly myopic macular hole eyes with retinal detachment.