Comparison of superior and temporal inverted internal limiting membrane techniques in macular hole surgery: Surgical outcomes and the role of postoperative positioning.

Abstract

Purpose: To compare the anatomical and functional outcomes of macular hole (MH) cases treated with superior and temporal inverted internal limiting membrane (ILM) flap surgery under general anesthesia and to assess the impact of postoperative positioning on surgical success.

Methods: This retrospective study included 25 patients with superior and 19 with temporal inverted ILM flap surgery. BCVA was evaluated preoperatively and at 1, 3, and 6 months, with MH parameters and closure patterns (U, V, and W) assessed at 6 months. Postoperatively, superior flap patients were positioned upright for 5 days, while temporal flap patients were positioned prone.

Results: Among 44 patients, one in the superior group and two in the temporal group required a second surgery, with a primary success rate of 93%. MH diameters were similar between groups ( P > 0.05), but the superior group had a smaller postoperative ELM defect ( P < 0.05). Visual acuity was similar preoperatively and up to 3 months ( P > 0.05), but the superior group showed better outcomes at 6 months ( P < 0.05).

Conclusion: Results of our study indicate that the superior inverted ILM flap under general anesthesia is non-inferior to the temporal flap, with better patient compliance in the sitting position postoperatively.