Surgical outcomes of small and medium macular holes with or without use of internal limiting membrane flaps.

Objective: This study aims to evaluate the long-term visual and anatomical outcomes of the inverted flap technique in small-to-medium sized macular holes (MH).

Design: Retrospective chart review.

Participants: Consecutive patients who underwent macular hole surgery at a single retina center in Alberta, Canada.

Methods: Macular hole surgeries were stratified on the basis of size. Postsurgical visual outcomes and hole closure rates were captured. Large holes were excluded from analysis.

Results: A total of 239 medium and 252 small holes were included; 65 medium and 40 small holes had internal limited membrane (ILM) flaps. In the small MH group, mean hole size was 170.7 μm, and visual gain averaged 6.4 ETDRS letters, with no significant difference based on surgical technique (p = 0.7). All small holes closed with ILM flapping with 4 (2%) of the ILM peels not closing, this was not significant (p = 0.4). In medium MH, mean hole size was 320.9 μm, and visual gain averaged 11.9 ETDRS letters, with no significant difference based on surgical technique (p = 0.5). All medium holes closed with ILM flapping, with 8 (5%) of the standard ILM peel not closing; this was not significant (p = 0.08).

Conclusions: There was no significant difference in either surgical closure rates or visual acuity gains when comparing ILM peeling to the flap technique for both small and medium-sized MH.