Surgical repair of a giant idiopathic macular hole by inverted internal limiting membrane flap

Abstract

A 22-year-old male patient presented with gradual outward deviation of the right eye following corneal tear repair in that eye 8 years prior. He was asymptomatic in the left eye. On examination, his best corrected visual acuity was counting fingers at 2 m in the right eye and 20/80 in the left eye. The left eye showed a large macular hole, 2845 µm in diameter, with a retinal detachment at the posterior pole. The patient underwent pars plana vitrectomy, internal limiting membrane (ILM) peeling with inverted ILM flap technique and silicone oil injection. At the 1-week follow-up visit, there was growth of retinal tissue under the ILM flap. At 2-month follow-up, there was a complete closure of the macular hole and visual acuity was 20/100. At this time, the patient underwent removal of the silicone oil, following which visual acuity was maintained at 20/100.

Figure 1

(A) Baseline colour fundus photograph showing a giant macular hole. (B) Optical coherence tomography (OCT) at baseline showing a large hole with retinal detachment. (C) OCT at 1 week showing a thin internal limiting membrane (ILM) flap with edges of the hole attached to the retinal pigment epithelium. Retinal tissue (thick arrow) is seen to be growing under the ILM flap (thin arrow). (D) OCT at 2 months showing the hole to be completely closed.