Outcomes of a Novel Technique That Does Not Require Head Position in Macular Hole Surgery: Application of Viscoelastic on an Inverted ILM Flap Under Air.

Abstract

Purpose: To report outcomes of a novel technique involving the injection of a dispersive viscoelastic device on to inverted temporal internal limiting membrane (ILM) flap under air for macular hole (MH) closure, without requiring postoperative head positioning.

Methods: A temporal ILM flap was created in all patients and inverted over the MH with perfluorocarbon liquid (PFCL). After a fluid-air exchange, a PFCL-air exchange was done. Afterwards, a dispersive viscoelastic agent was applied around the inverted flap under air, covering an area of two-to-three-disc diameters. An air-sulfur hexafluoride (SF6) exchange was then performed, and the sclerotomies were closed. No head positioning was adviced postoperatively. Data on preoperative MH size, best-corrected visual acuity (BCVA), MH closure rate, and closure pattern were collected.

Results: The study included 114 eyes from 106 patients. Initial MH closure was achieved in 112 eyes (98.2%), with two cases closed after a second surgery. U-shaped closure occurred in 71.9%, V-shaped in 20.1%, and W-shaped in 8%. Significant BCVA improvement was observed (p<0.001), with no significant change in IOP (p=0.881).

Conclusion: This technique enhances flap stabilization, facilitates MH closure, and eliminates the need for postoperative head positioning, leading to favorable anatomical and functional outcomes with improved patient comfort.