• Retina/Vitreous

    Review of: Inverted internal limiting membrane flap vs complete internal limiting membrane peeling for large macular holes in nonposturing surgery

    Rahman R, Sarfraz M, El-Wardani M, Journal of VitreoRetinal Disease, January 2022

    This small study shows greater improvement in visual acuity in patients who underwent internal limiting membrane (ILM) peeling vs. the inverted ILM flap technique to repair macular holes.

    Study design

    This was a retrospective, comparative, single-surgeon study of 46 eyes examining functional and anatomical outcomes of inverted ILM flap compared with complete ILM peeling in surgery without posturing for full thickness macular holes greater than 400 μm.


    Although 100% of macular holes closed in both groups, complete ellipsoid zone recovery was shown in 30% of the ILM peel group and 14% of the ILM flap group. The difference between these two groups was not statistically significant. Visual acuity improvement was statistically significant in favor of ILM peeling compared with ILM flap.


    This study had only a small number of patients, so there is not enough power to achieve significance. Also, it is not randomized, so there may be issues with selection bias.

    Clinical significance

    There are several various surgical techniques and positioning requirements used to close large macular holes. In this study, all macular holes in both groups closed without positioning, which is notable on its own. ILM peeling led to greater improvement in visual acuity than ILM flap. However, this study is rather small, so the results should be applied with caution.