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    Modified Simple Technique for ILM Free Flap Transplantation in MH Surgery: The Peel-PFCL-Peel Technique

    AAO 2020 Video Program
    Retina/Vitreous, Vitreoretinal Surgery

    Internal limiting membrane (ILM) flaps may improve outcomes, recreate anatomic integrity and restore useful vision in large or refractory macular holes (MH) by providing a scaffold to promote cell migration and tissue repair. Unfortunately, this technique may be demanding for beginning or even experienced surgeons. We describe a simple variant technique that utilizes perfluorocarbon liquid (PFCL) to assist in manipulating the ILM free flap. After creating a small ILM edge (the first peel), a large PFCL bubble is then subsequently injected over the posterior pole. The high density and high interfacial tension of the PFCL then works to provide counter-traction during peeling, catch and trap the free flap, and enable multiple regraspings and maneuvering of the flap for proper placement within the MH. This Peel-PFCL-Peel technique is an easy-to-remember variant sequence and an efficient way to stabilize and immobilize the ILM free flap, improving surgeon control and reducing overall surgical time.