An Innovative Pear Flower Petal–Shaped Inverted Internal Limiting Membrane Flap Technique for Macular Holes with or Without Retinal Detachment—There is Always a Flap That Works for You

Purpose: To introduce a modified, effective, and versatile inverted internal limiting membrane flap technique, providing a novel option for the treatment of macular holes, with or without retinal detachment. Methods: We conducted a retrospective analysis of 20 patients (20 eyes) with macular holes who underwent pars plana vitrectomy using the pear flower petal–shaped inverted internal limiting membrane flap technique. Best-corrected visual acuity, optical coherence tomography, and morphological assessments were performed at baseline and during each postoperative follow-up visit. Results: Postoperative macular holes closure and retinal reattachment rates were both 100%. The baseline best-corrected visual acuity was logMAR 1.892 ± 0.495, which significantly improved to logMAR 0.968 ± 0.348 at the final follow-up ( P < 0.001). Optical coherence tomography imaging demonstrated favorable postoperative retinal microstructural recovery, with a healing process highly similar to that observed in spontaneous closures. Conclusion: This novel technique promotes anatomical and functional recovery in patients with macular holes, with or without retinal detachment, resembling the natural healing process. It serves as a remedial measure in case of intraoperative complications, offering a simple and flexible approach, ensuring that there is always a suitable flap for each situation.