Early Surgical Outcomes of Inverted Internal Limiting Membrane Flap Versus Internal Limiting Membrane Peeling in Macular Holes Larger Than 400 µm

Background:Large macular holes are surgically challenging, with lower closure rates and less predictable visual recovery than smaller holes.Although the inverted internal limiting membrane (ILM) flap technique has been associated with improved anatomical closure compared with conventional ILM peeling, its early functional benefit and relationship with outer retinal recovery are less clear.This study compared early postoperative anatomical and functional outcomes of the inverted ILM flap technique (IF) and complete ILM peeling (ILMP) in macular holes larger than 400 μm. Material/Methods:This retrospective comparative study included 29 eyes of 29 patients with large macular holes who underwent pars plana vitrectomy.Nineteen eyes underwent ILMP and 10 underwent IF.Best-corrected visual acuity (BCVA), hole closure, and ellipsoid zone (EZ) recovery were evaluated at 1 month. Results:Baseline hole dimensions were significantly larger in the IF group.Mean BCVA (LogMAR) improved from 0.97 ± 0.24 to 0.72 ± 0.43 in the ILMP group and from 1.06 ± 0.19 to 0.39 ± 0.14 in the IF group at 1 month.The betweengroup difference was not significant (P = 0.09).Hole closure rate was significantly higher in the IF group than in the ILMP group (100.0%[10/10; exact 95% CI, 69.2%-100.0%]vs 52.6% [10/19; exact 95% CI, 28.9%-75.6%],P = 0.009), corresponding to an absolute difference of 47.4 percentage points (95% CI, 13.1%-68.3%).No significant difference was observed in EZ recovery between the groups. Conclusions:The IF technique was associated with higher early anatomical closure than ILMP despite larger baseline hole dimensions.Larger studies with longer follow-up are needed to confirm these findings.