Internal limiting membrane (ILM) flap reposition facilitates preservation of the inner retina in surgically closed full-thickness macular holes.

Purpose: To compare inner retinal thinning after an Internal Limiting Membrane (ILM) flap reposition technique to ILM peeling in full-thickness macular holes (FTMH).

Methods: This retrospective study included a total of 78 eyes (71 consecutive patients) with primary FTMH undergoing vitrectomy between 10/2022 -12/2023. Exclusion criteria were secondary macular holes, high myopia, glaucoma and prior surgery except cataract-surgery. Eyes were separated by surgical technique into Group A (ILM flap repositioning; n = 30) and Group B (ILM peeling alone n = 48). We compared mean thickness/volume of parafoveal (3 mm) and perifoveal (6 mm Early Treatment Diabetic Retinopathy Study subfields) Retinal Nerve Fiber Layer (RNFL), Ganglion Cell Layer (GCL) and Inner Plexiform Layer (IPL) at six months after surgery (M6) to baseline (M0). Secondary, we assessed anatomical closure rate and visual acuity.

Results: Anatomical type 1 closure was achieved in 90.00% (A) and 80.00% (B) without significant difference. For consistency in the subsequent analysis, only cases with successful closure were included. Preservation analysis at M6 showed thicker (P = .006) and more volume (P = .010) in parafoveal RNFL in Group A, whereas perifoveal GCL remained thicker (P = .001) and with more volume (P = .002) in Group A. IPL did not differ between the groups. Visual acuity improved by time (P < .001) without differing between the groups.

Conclusions: Compared to ILM peeling, macular hole treatment with ILM flap repositioning results in better preserved RNFL and GCL, while maintaining a high closure rate and similar postoperative visual acuity.