Multilayer Hinged ILM Flap for Recurrent Macular Hole

Drs. Ferhina Ali and Richard Kaiser used a multilayered, inferotemporal hinged internal limiting membrane (ILM) flap to treat a patient with a recurrent macular hole. The 51-year-old patient had previously undergone vitrectomy with a posterior vitreous detachment and ILM peeling, which had failed to mend the lesion. In this surgery, they extended the membrane from the previous ILM peel, folded it into multiple layers and secured it over the hole using viscoelastic followed by an air-fluid exchange. Macular hole repair was visible by postop week 3. At 2 months postop, OCT imaging revealed good reconstitution of the outer retinal anatomy. The surgery improved the patient’s vision from 20/200 to 20/60.

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