Manoj Soman¹*, Venkata Sarath Babu Pasupaleti¹, Mradula Gangwar¹, Asmita Indurkar² and Unnikrishnan Nair R¹

¹Vitreoretinal Services, Chaithanya Eye Hospital & Research Institute, Trivandrum, India
²Cleveland Clinic, Cleveland, OH, USA

*Corresponding Author: Manoj Soman, Vitreoretinal Services, Chaithanya Eye Hospital & Research Institute, Trivandrum, India.

Received: September 10, 2026; Published: September 28, 202

Abstract

Purpose: To compare the anatomical and functional outcomes of two techniques for large idiopathic full-thickness macular holes: inverted internal limiting membrane (ILM) flap versus conventional ILM peeling with flute-needle vacuum–assisted closure.

Methods: This prospective randomized study included 100 eyes with idiopathic FTMH (408-1500μm). Group A (n = 50) underwent pars plana vitrectomy (PPV) with ILM peeling plus flute-needle vacuum assisted closure, and Group B (n = 50) underwent PPV with the inverted ILM flap technique. Outcomes included anatomical closure (Type 1 vs Type 2), best-corrected visual acuity (BCVA, logMAR, and outer retinal integrity including external limiting membrane (ELM), ellipsoid zone (EZ) on OCT at baseline and 6 months.

Results: All 100 eyes (100%) in group A and B achieved closure at 6 months. Group A had 45 eyes with type 1 closure and 5 eyes with type 2 closure while group B had 47 eyes with type 1 closure and 3 eyes with type 2 closure. Preoperative BCVA was logMAR 0.685 in group A and 0.677 in group B. At 6 months, BCVA improved to logMAR 0.398 in group A and 0.462 in group B. Mean BCVA gain (0.287 vs 0.215 logMAR) was not significantly different between the groups. The mean diameter of EZ disruption and external limiting membrane disruption were significantly smaller with both surgical techniques.

Conclusions: Both inverted ILM flap and flute-needle–assisted ILM peeling achieved high closure rates and significant visual improvement in large idiopathic FTMH. At 6 months, there were no significant differences in hole closure rates or visual outcomes.

Keywords: Full Thickness Macular Hole; Inverted ILM Flap; Flute-Needle Technique; ILM Peeling

References

1. Ullrich S., et al. “Macular hole size as a prognostic factor in macular hole surgery”. British Journal of Ophthalmology 4 (2002): 390-393.
2. Michalewska Z., et al. “Inverted internal limiting membrane flap technique for large macular holes”. Ophthalmology 10 (2010): 2018-2025.
3. Chakraborty D., et al. “Anatomical and functional outcomes one year after vitrectomy and retinal massage for large macular holes”. Indian Journal of Ophthalmology 4 (2021): 895-899.
4. Shukla D., et al. “A preliminary study of Heavy Brilliant Blue G for internal limiting membrane staining in macular hole surgery”. Indian Journal of Ophthalmology6 (2012): 531-534.
5. Kannan NB., et al. “Outcome of 2 cc pure sulfur hexafluoride gas tamponade for macular hole surgery”. BMC Ophthalmology 16 (2016): 73.
6. Landolfi M., et al. “Macular holes”. Ophthalmology Clinics of North America4 (2002): 565-572.
7. Rizzo S., et al. “Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes: A comparative study in a large series of patients”. Retina 38 (2018): S73-S78.
8. Kase S., et al. “Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique”. Clinical Ophthalmology 11 (2016): 9-14.
9. Manasa S., et al. “Comparative Evaluation of Standard ILM Peel With Inverted ILM Flap Technique In Large Macular Holes: A Prospective, Randomized Study”. Ophthalmic Surgery, Lasers and Imaging Retina4 (2018): 236-240.
10. Shiode Y., et al. “The Role of Inverted Internal Limiting Membrane Flap in Macular Hole Closure”. Investigative Ophthalmology and Visual Science 11 (2017): 4847-4855.
11. Kumagai K., et al. “Clinical features of idiopathic macular holes”. Nippon Ganka Gakkai Zasshi11 (2000): 819-825.
12. Kumagai K., et al. “Factors related to initial success in macular hole surgery”. Nippon Ganka Gakkai Zasshi 11 (2000): 792-796.
13. Ip MS., et al. “Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography”. Archives of Ophthalmology1 (2002): 29-35.
14. Amari F., et al. “Predicting visual outcome after macular hole surgery using scanning laser ophthalmoscope microperimetry”. British Journal of Ophthalmology1 (2001): 96-98.
15. Smiddy WE., et al. “Internal limiting membrane peeling in macular hole surgery”. Ophthalmology 8 (2001): 1471-1476; discussion 1477-1478.
16. Ryan EH Jr and Gilbert HD. “Results of surgical treatment of recent-onset full-thickness idiopathic macular holes”. Archives of Ophthalmology12 (1994): 1545-1553.

Citation

Citation: Manoj Soman., et al. “Comparative Outcomes of Inverted ILM Flap vs. Flute Needle Assisted Peeling for Large Macular Holes". Acta Scientific Ophthalmology 9:10 (2026): 13-18.

Copyright

Copyright: © 2026 Manoj Soman., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.