Innovative Non-Inverted ILM Free Flap Covering Technique for Unclosed Macular Hole Repair.

OBJECTIVE To examine the safety and effectiveness of non-inverted ILM Free Flap combined with the SPOT technique (Sub-Perfluorocarbon liquid (PFCL) injection of Ocular viscoelastic device (OVD) Technique) in the treatment of unclosed macular holes (MHs). DESIGN Retrospective interventional case series. PARTICIPANTS Eight patients (8 eyes) with persistent unclosed MHs were treated at a tertiary eye hospital in China from September 2023 to February 2025. All procedures were performed by the same vitreoretinal surgeon(P.Q.Z.). METHODS Enhanced ILM peeling and a limited ILM flap harvested outside the peeling margin to cover the MH. A combination of PFCL and OVD (SPOT technique) was applied to stabilize the ILM flap. MAIN OUTCOMES AND MEASURES Primary outcome was anatomical closure of the MH within one month postoperatively. Secondary outcomes included best-corrected visual acuity (BCVA) and structural restoration of the external limiting membrane (ELM), outer nuclear layer (ONL), and ellipsoid zone (EZ) on optical coherence tomography (OCT). RESULTS All MHs achieved anatomical closure within one month. U-shaped closure was noted in six eyes (75%) and V-shaped in two eyes (25%). BCVA improved in all eyes at final follow-up. OCT showed reconstitution of the ELM, ONL, and EZ bands in all cases. CONCLUSIONS These findings demonstrate that the innovative combination of the non-inverted, single-layered ILM-free flap with the SPOT technique is effective in treating unclosed MH and improving VA. This approach offers a new solution for unclosed MH and its effectiveness needs to be validated by more well-designed research.