it was a prospective , non - randomized , interventional case - series study of patients with large macular holes .
all patients in the study had idiopathic large macular holes as determined by bio microscopy and optical coherence tomography ( oct ) imaging .
exclusion criteria were macular holes of < 700 m and macular hole due to other causes .
demographic and clinical data were collected for all patients , including age , sex , best - corrected visual acuity ( bcva ) and intraocular pressure .
slit - lamp bio microscopy of the anterior segment and fundus with + 90 d was also done .
the diagnosis of macular hole in all patients was confirmed using spectral - domain oct .
the follow - up was done at day 1 , day 7 , 1 month , 2 months and 6 months .
final bcva was recorded and complete ophthalmic evaluation with oct imaging was done during all the visits .
all patients underwent 23 g three - port pars plana vitrectomy with posterior vitreous detachment induction using triamcinolone acetonide .
brilliant blue dye assisted ilm peeling was done and instead of completely removing the ilm , a remnant of ilm attached to the margins of the macular hole was left in place and inverted into the hole after trimming with cutter .
all patients underwent 23 g three - port pars plana vitrectomy with posterior vitreous detachment induction using triamcinolone acetonide .
brilliant blue dye assisted ilm peeling was done and instead of completely removing the ilm , a remnant of ilm attached to the margins of the macular hole was left in place and inverted into the hole after trimming with cutter .
demographic data and variables were analyzed [ table 1 ] . there were a total of five patients .
the mean minimal linear diameter of the macular holes was 811.4 m ( 728 - 995 m ) [ figs 1 , 3 , 5 ] .
mean bvca pre - operatively was 1.22 log - mar units ( 1.10 - 1.22 log mar units ) .
post - operatively , mean bcva was 1.10 log mar units ( 1.0 - 1.52 log mar units ) .
improvement of visual acuity was registered in all patients ( 100% ) [ figs . 2 , 4 , 6 ] . there were no intraoperative or post - operative complications .
demographic and clinical profile of patients pre - operative optical coherence tomography of patient one post - operative optical coherence tomography of patient one pre - operative optical coherence tomography of patient three post - operative optical coherence tomography of patient three pre - operative fundus photo of patient one post - operative fundus photo of patient one
the improvement in technique and development of finer instrumentation in vitreo - retinal surgery has significantly improved the surgical outcome of macular holes in terms of anatomical and functional success .
the vitrectomy for treatment of macular hole study group showed a clear benefit in closure rates and final visual acuity with surgery versus observation for stage iii and iv macular hole .
the single most reliable factor affecting the surgical outcome following surgery is the size of the hole .
a number of studies have established that the mld of the hole is closely related to the rate of anatomic success . also , it has been shown that the most favorable outcomes for visual recovery were associated with better initial visual acuity . among all the different techniques for macular hole surgery ,
the one with the most positive effect on final outcome is vitrectomy with ilm peeling , in order to release tangential forces acting on the macular hole ( mh ) .
in addition to promoting hole closure , peeling of the ilm also reduces the probability of its reopening .
dye assisted technique is safe and useful in visualizing the ilm , leading to the performance of successful peeling of ilm with minimal damage to the retina .
brilliant blue selectively stains the ilm and can be safely used for staining the ilm .
the peeled - off ilm contains mller cell fragments which can induce gliosis and helping in closure of macular hole .
thus , if a segment of peeled - off ilm is left attached , it may provoke gliosis both inside the retina and on the surface of the ilm .
michalewska et al . observed closure of the macular hole by a thin membrane with an appearance consistent with the ilm .
our study found that the closure rate of macular hole following this technique was 100% and the functional outcome were also better .
but , a larger study group and longer follow - up period is required to further evaluate this method .
 we are presenting the initial results of inverted internal limiting membrane ( ilm ) flap technique for large macular hole . 
 five eyes of five patients with large diameter macular hole ( > 700 m ) were selected . 
 all patients underwent inverted ilm flap technique for macular hole . 
 anatomical closure and functional success were achieved in all patients . 
 there was no loss of best - corrected visual acuity in any of the patients . 
 inverted ilm flap technique in macular hole surgery seems to have a better hole closure rates , especially in large diameter macular holes . 
 larger case series is required to assess the efficacy and safety of this technique . 
Materials and Methods
Surgical technique
Results
Discussion