Symptomatic Visual Disturbance from Internal Limiting Membrane Flaps After Successful Macular Hole Repair: A Case Series

Purpose: The inverted internal limiting membrane (ILM) flap technique significantly improved closure rates for routine, complex, or chronic full-thickness macular holes (FTMH). However, ILM flap is still an evolving technique and postoperative complications are not well described. Methods: We report two cases of patients who underwent pars plana vitrectomy (PPV) using the inverted flap technique that subsequently developed visual disturbances associated with a mobile ILM flap. Results: Both patients reported visual disturbance, with one describing a “tentacle-like” movement in the visual field. Spectral-domain optical coherence tomography (SD-OCT) in both cases revealed mobile, partially dehisced ILM flaps over the macula. PPV was repeated with removal of the ILM flap, resulting in immediate resolution of visual symptoms. Conclusion: Symptomatic mobile ILM flaps represent an unusual and underrecognized complication of the inverted ILM flap technique.