The Cloverleaf Internal Limiting Membrane Flap Technique for Repair of Challenging Macular Holes

Purpose: This study introduces the cloverleaf internal limiting membrane (ILM) flap technique for managing challenging macular holes, aiming to enhance ILM flap placement and improve functional and anatomical outcomes. Methods: A retrospective review of cases undergoing the cloverleaf ILM flap technique was conducted at a single center. This technique involves creating multiple ILM flaps in a cloverleaf configuration to enhance the stability and coverage of the macular hole. Clinical characteristics, surgical details, and outcomes were analyzed. Visual acuity measurements were converted to logMAR values. Results: The study included 29 eyes of 29 patients with a mean age of 65.3 years, and 58.6% females. Macular hole aperture and base sizes were 423.7 (±264.9) µ m and 1017.5 (±229.0) µ m, respectively. Preoperatively, 62.1% of cases were phakic and 37.9% were pseudophakic. The median duration of symptoms was 90 (interquartile range: 60–300) days, with surgery performed approximately 34 (interquartile range: 28–69) days after presentation. Anatomical closure was achieved in 93.1% of cases. Patients had a mean 4.5 (±4.4) Snellen lines of improvement in their visual acuity. The median duration of follow-up was 118 (interquartile range: 36–1,491) days. Conclusion: The cloverleaf ILM flap technique may serve as a promising approach for challenging macular holes. By creating a cloverleaf configuration of quadratic ILM flaps folded over the macular hole, this technique enhances flap stability, potentially improving macular hole closure success.