# Efficacy of the Semicircular Inverted Internal Limiting Membrane Flap Technique for Macular Hole Retinal Detachment in Hyperopic Eyes: A Case Series

## TL;DR

This case series shows that a specific surgical technique can effectively treat retinal detachment in hyperopic eyes with macular holes.

## Contribution

The study introduces the use of a semicircular inverted ILM flap for hyperopic macular hole retinal detachment.

## Key findings

- All three patients achieved immediate macular hole closure and retinal reattachment after 18-24 months.
- Visual acuity improved in two patients, with OCT showing foveal restoration and ELM/EZ integrity.
- No intraoperative complications or recurrence were observed, supporting the technique's feasibility and reliability.

## Abstract

We report anatomical and functional outcomes for three hyperopic phakic women with macular hole retinal detachment (MHRD) treated using a superiorly based semicircular inverted internal limiting membrane (ILM) flap. All patients underwent 25-gauge pars plana vitrectomy with Brilliant Blue G-assisted ILM manipulation, inversion of a superior semicircular flap to cover the macular hole, and 20% sulfur hexafluoride (SF₆) tamponade. Postoperative assessment included decimal best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (OCT). All eyes achieved immediate macular hole closure, and complete retinal reattachment was attained after 18-24 months. Final BCVA improved in two eyes (from 0.1 to 0.4) and remained 0.2 in one eye, underscoring delayed but meaningful recovery in hyperopic MHRD treated with a semicircular inverted ILM flap. OCT demonstrated stepwise foveal restoration with variable ellipsoid zone/external limiting membrane (ELM/EZ) integrity across cases, and no intraoperative complications, macular hole reopening, or recurrent detachment were observed. These findings indicate that in hyperopic MHRD, a semicircular inverted ILM flap is feasible and mechanically reliable for early hole closure, while SRF absorption and functional recovery may require prolonged follow-up, likely reflecting the timeline of outer-retinal reconstruction.