Complex macular hole closure by temporal internal limiting membrane flap without endotamponade

To evaluate the safety, efficacy and imaging features of a novel surgical technique without endotamponade in repairing complex macular hole (MH). Retrospective review of consecutive cases with complex MH underwent pars plana vitrectomy (PPV) with temporal internal limiting membrane (ILM) flap, which was stabilized using perfluorocarbon liquid (PFCL) and viscoelastics. At conclusion of surgery, PFCL was removed and no endotamponade agent would be used. Complex MH was defined as a basal linear diameter (BLD) >/= 400μm and/or associated with high myopia (HM). Visual acuity (VA), pattern of MH closure on optical coherence tomography (OCT), formation of epi-retinal membrane (ERM) and operative complications, were reported. Twenty-four eyes were included and the mean BLD was 988.3μm. MH closure was achieved in 24 (100%), of which 8 (33%) achieved type 1A closure. The mean post-operative logMAR VA 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 (12.5%) eyes and 10 (41.7%) developed nasal ERM. One eye developed vitreous hemorrhage which resolved spontaneously. This novel surgical technique which requires no endotamponade is effective in achieving complex MH closure. A substantial proportion of patients developed ERM and its clinical significance requires further investigation.