Inverted Internal Limiting Membrane Flap for Full-Thickness Macular Hole Repair

Standard three-port vitrectomy was performed using a 23-gauge system (DORC, Zuidland, The Netherlands) by a single surgeon (M. M.) in all patients. Phacoemulsification with intraocular lens (IOL) implantation was performed if a visually significant cataract was present. After core and peripheral vitrectomy, the ILM was stained with 0.025% Brilliant Blue G (Brilliant Peel, Fluoron, Germany). A potentially present ERM was differentiated from the ILM by its staining pattern and peeled consequently. In all cases, the I-ILM flap cover technique was performed creating a radial I-ILM flap (I-ILM flap rosette) to cover the FTMH [40 (link), 41 (link)]. At the end of the surgery, 12% perfluoropropane (C3F8; Perfluoron, Alcon Laboratories, Fort Worth, TX, USA) was substituted in all cases. All patients were instructed to maintain a face-down position for 3 days after surgery. Dynamic intraoperative imaging with the microscope integrated iSD-OCT system Rescan 700 (Carl Zeiss Meditec AG, Oberkochen, Germany) was used to reassure a safe and controlled surgery with correct flap positioning at the end of surgery.