Macular hole repair using a refined viscoelastic assisted membrane positioning technique markedly improves surgical success rates

Abstract Introduction To evaluate the surgical outcomes of pars plana vitrectomy (PPV) using dispersive viscoelastic-assisted inverted internal limiting membrane (VILM) flap technique in patients with full-thickness macular holes (MH). Methods We retrospectively review 247 eyes that underwent PPV with the VILM flap technique and had a minimum follow-up of six months. Following core vitrectomy, the internal limiting membrane (ILM), stained with indocyanine green, was placed on the MH. A dispersive viscosurgical device was applied over the ILM flat to secure its placement before fluid-gas exchange. Sulfur hexafluoride gas was used for tamponade, and patients maintained face-down positioning postoperatively. The primary outcomes assessed were anatomical closure of MH at 90 days confirmed with optical coherence tomography and changes in best-corrected visual acuity (BCVA). Results Anatomical closure of MH was achieved in 98% of eyes at 90 days postoperatively. Success rates were inversely correlated with MH diameter: 100% for small (< 400 μm; n = 122), 98% for medium (400–800 μm; n = 102), and 91.3% for large (> 800 μm; n = 23) holes. The median improvement in BCVA was 0.3 logMAR. Significant improvement in BCVA was observed at three months (p = 0.025) and six months ( p = 0.019) postoperatively. Final BCVA improved in 87% of eyes (n = 215), remained stable in 11% (n = 27), and worsened in 2% (n = 5). No cases of ILM flap displacement were noted. Conclusion The VILM flap technique during PPV is highly effective for treating MH, demonstrating high anatomical closure rates and significant visual improvement. This method enhances the likelihood of successful outcomes after initial surgery.