LAUSR

PURPOSE To compare the outcomes of using an internal limiting membrane (ILM) flap and the conventional ILM peel technique for small- or medium-sized full-thickness macular hole (FTMH) repair. DESIGN Retrospective, interventional case series. METHODS Eyes with an FTMH ≤ 400 µm that underwent vitrectomy with either a single-layer inverted ILM flap (flap group, 55 eyes) or an ILM peel (peel group, 62 eyes) were enrolled. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) measurements were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. RESULTS Primary hole closure was achieved in 54 (98%) and 60 (97%) eyes in the flap and peel groups, respectively. The preoperative and postoperative 12-month BCVA were comparable between the groups but were significantly better in the flap than in the peel groups at 1 month (logMAR, mean ± SD, 0.83 ± 0.43 vs. 1.14 ± 0.50, P = 0.001), 3 months (0.58 ± 0.33 vs. 0.82 ± 0.43; P = 0.002), and 6 months (0.56 ± 0.32 vs. 0.72 ± 0.48; P = 0.028). In the flap group, foveal gliosis was less common than the peel group at 1 month (P = 0.030) and restored external limiting membrane and interdigitation zone was more common at 3 months (P = 0.046 and < 0.001, respectively). CONCLUSIONS Both the single-layer ILM flap and conventional ILM peel techniques closed FTMHs and improved vision. ILM flaps were associated with better visual outcomes up to 6 months postoperatively and should be considered in FTMHs ≤ 400 µm.