COMPLEX MACULAR HOLE CLOSURE BY TEMPORAL INTERNAL LIMITING MEMBRANE FLAP WITHOUT ENDOTAMPONADE

Supplemental Digital Content is Available in the Text.Temporal internal limiting membrane flap without gas endotamponade is effective in closing complex macular hole (MH), including large MH and MH associated with high myopia. Retinal surgeons may consider using this technique for complex MH, particularly in patients with only-seeing eye, preexisting glaucoma, or noncompliant to posturing. Purpose:To evaluate the safety, efficacy, and imaging features of a novel surgical technique without endotamponade in repairing complex macular hole (MH).Methods:Retrospective review of consecutive cases with complex MH underwent pars plana vitrectomy with temporal internal limiting membrane flap, which was stabilized using perfluorocarbon liquid and viscoelastics. At the conclusion of surgery, perfluorocarbon liquid was removed, and no endotamponade agent would be used. Complex MH was defined as a basal linear diameter of >= 400 mu m and/or associated with high myopia. Visual acuity, pattern of MH closure on optical coherence tomography, formation of epiretinal membrane, and operative complications were reported.Results:Twenty-four eyes were included, and the mean basal linear diameter was 988.3 mu m. MH closure was achieved in 24 (100%), of which, 8 (33%) achieved type 1A closure. The mean postoperative logarithm of the minimum angle of resolution visual acuity improved from 0.93 at baseline to 0.74, 0.51, 0.55, and 0.52 at 1-month, 3-month, 6-month, and last follow-up, respectively. Foveal gliosis was observed in 3 eyes (12.5%), and 10 (41.7%) developed nasal epiretinal membrane. One eye developed vitreous hemorrhage, which resolved spontaneously.Conclusion:This novel surgical technique that requires no endotamponade is effective in achieving complex MH closure. A substantial proportion of patients developed epiretinal membrane, and its clinical significance requires further investigation.