# Positive Rotational Internal Limiting Membrane Covering Technique for Large Idiopathic Macular Holes

## TL;DR

A new surgical technique using a rotated internal limiting membrane flap successfully closes large macular holes and improves vision.

## Contribution

A novel positive rotational internal limiting membrane covering technique for treating large idiopathic macular holes is introduced and evaluated.

## Key findings

- All 13 patients showed successful closure of large idiopathic macular holes.
- Visual acuity improved significantly after the procedure.
- Postoperative improvements in ellipsoid zone and external limiting membrane defects were observed.

## Abstract

This article aims to determine the efficacy of a modified technique by a positive rotational internal limiting membrane (ILM) covering for the treatment of large idiopathic macular holes (IMHs).

A prospective analysis was conducted on a cohort of 13 patients with large IMH (> 400 μm). The ILM was dissected in approximately one diameter width of the optic disc from the inferior and temporal sides. Subsequently, a pedicled ILM flap connected to the optic disc was grasped and peeled from the superior edge of the residual ILM with a width of at least 2 papilla diameters (PDs). The pedicled ILM flap was then directly rotated to cover the IMH in a positive way. Some peeled‐off ILM samples were collected for scanning electron microscopy (SEM) examinations. During each follow‐up, best‐corrected visual acuity (BCVA), SD‐OCT scans, and M‐CHARTS were performed.

The study successfully detected IMH closure in all cases. The mean BCVA (logMAR) showed a decrease from 1.18 ± 0.209 to 0.58 ± 0.202 (p < 0.001). Postoperatively, there was a significant reduction in the diameter of the ellipsoid zone (EZ) and external limiting membrane (ELM) defects compared to preoperative values (p < 0.001). Additionally, the defect size decreased further at the 3‐month follow‐up compared to the 1‐month follow‐up. Both horizontal and vertical deformations postoperatively showed significant improvements (p = 0.001, p < 0.001). At the final follow‐up, 7 eyes exhibited U‐shaped closure while 6 eyes showed V‐shaped closure.

This technique is an effective treatment for larger IMHs. This technique has the potential to improve vision outcomes.

Trial Registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR2300068411