Pars Plana Vitrectomy with Internal Limiting Membrane Peeling using Inverted Flap Technique in Full-Thickness Macular Hole Stage IV with Posterior Vitreous Detachment

Abstract

Objective: To document a case of macular hole managed with an innovative new procedure, the Inverted Flap Technique of Internal Limiting Membrane (ILM) Peeling. Methods: A 67-year-old female presented with central visual loss on left eye for more than a year. Pre-operative visual acuity of counting fingers at 2 feet. Baseline macular Optical Coherence Tomography (OCT) showed a large full thickness macular hole measuring 710 μm in diameter associated with chronic cystoid degenerative changes and posterior vitreous detachment. The patient underwent Closed Vitrectomy with Inverted Flap Technique of ILM Peeling. Intra-ocular air tamponade was done and face down position was advised for 5 days. Result: One-month post-operative showed reduction in size of the macular hole with a decrease in diameter to less than half (310 μm) of its initial measure (710 μm). Three months post-operative showed decreased diameter to 262 μm. Visual acuity improved from counting fingers at 2 feet to 3/60 to 5/60 respectively. Conclusion: The Inverted Flap Technique of ILM Peeling is capable of successfully managing even large and chronic full thickness macular hole resulting in limited recovery of vision.