# Novel dual-layer internal limiting membrane flap with superior-inferior coverage combined with autologous blood application for large macular hole: anatomical and functional outcomes

## TL;DR

A new surgical technique using a dual-layer membrane flap and blood tamponade successfully closes large macular holes and improves vision.

## Contribution

A novel dual-layer ILM flap with superior-inferior coverage combined with autologous blood tamponade for large macular holes.

## Key findings

- All 21 eyes achieved complete macular hole closure with a mean baseline diameter of 717.29 μm.
- Median best-corrected visual acuity improved significantly after surgery (p < 0.001).
- No sight-threatening complications were observed during follow-up.

## Abstract

To evaluate the efficacy of a novel dual-layer internal limiting membrane (ILM) flap with superior-inferior (S-I) coverage combined with autologous blood tamponade for the treatment of large macular hole (MH) > 400 μm in diameter.

This retrospective interventional case series included 21 eyes from 21 patients who underwent vitrectomy with the dual-layer ILM flap with S-I coverage combined with autologous blood tamponade between February 2022 and July 2024. The surgical procedure involved creating superior and inferior ILM flaps that were inverted to achieve dual-layer coverage over the MH, followed by application of autologous whole blood and 15% C3F8 gas tamponade. Primary outcomes included anatomical closure rate assessed by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA) improvement at 3-month follow-up.

All 21 eyes (100%) achieved complete MH closure, including cases with a mean baseline diameter of 717.29 ± 127.00 μm (range: 521–949 μm). Median logMAR BCVA significantly improved from 1.70 (IQR, 1.30–1.70) to 0.82 (IQR, 0.61–0.82) after the surgery (p < 0.001). No sight-threatening complications were observed during the follow-up period.

The dual-layer ILM flap with S-I coverage showed excellent anatomical and functional outcomes in large MH, indicating that this technique may be an effective surgical approach for challenging cases. Further randomized controlled trials are needed to validate these preliminary findings.