An Innovative Pear Flower Petal-Shaped Inverted Internal Limiting Membrane Flap Technique for Macular Holes with or Without Retinal Detachment — There's Always a Flap that Works for You.

Purpose: To introduce a modified, effective, and versatile inverted internal limiting membrane (ILM) flap technique, providing a novel option for the treatment of f macular holes (MH), with or without retinal detachment (RD). Methods: We conducted a retrospective analysis of 20 patients (20 eyes) with MH who underwent pars plana vitrectomy using the pear flower petal-shaped inverted ILM flap technique. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and morphological assessments were performed at baseline and during each postoperative follow-up visit. Results: Postoperative MH closure and retinal reattachment rates were both 100%. The baseline BCVA was logMAR 1.892 ± 0.495, which significantly improved to logMAR 0.968 ± 0.348 at the final follow-up ( p < 0.001). OCT imaging demonstrated favorable postoperative retinal microstructural recovery, with a healing process highly similar to that observed in spontaneous closures. Conclusions: This novel technique promotes anatomical and functional recovery in patients with MH, with or without RD, 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.