Internal limiting membrane flap transposition for surgical repair of macular holes in primary surgery and in persistent macular holes



Classical or temporal internal limiting membrane (ILM) flap transposition with air or gas tamponade are current trends with the potential to improve surgical results, especially in cases with large macular holes.


A prospective case series included patients with idiopathic macular holes or persistent macular holes after 23-G pars plana vitrectomy (PPV) and ILM peeling with gas tamponade. In all patients, 23-G PPV and ILM peeling with ILM flap transposition with gas tamponade and postoperative face-down position was performed.


In 7 of 9 eyes, temporal ILM flap transposition combined with pedicle ILM flap could be successfully performed and macular holes were closed in all eyes after surgery. The remaining 2 eyes were converted to pedicle ILM flap transposition with macular hole closure after surgery. Three eyes were scheduled as pedicle ILM flap transposition due to previous ILM peeling. In 2 of these eyes, the macular hole could be closed with pedicle ILM flap transposition. In 3 eyes, free ILM flap transposition was performed and in 2 of these eyes macular hole could be closed after surgery, whereas in 1 eye a second surgery, performed as pedicle ILM flap transposition, was performed and led to successful macular hole closure.


Use of ILM flaps in surgical repair of macular hole surgery is a new option of treatment with excellent results independent of the diameter of macular holes. For patients with persistent macular holes, pedicle ILM flap transposition or free ILM flap transposition are surgical options.

Post author correction


Article Subject: Vitreo SURG



Christoph Leisser, Nino Hirnschall, Birgit Döller, Ralph Varsits, Marlies Ullrich, Katharina Kefer, Oliver Findl

Article History


Financial support: No financial support was received for this submission.
Conflict of interest: Prof. Findl is a scientific advisor for Carl Zeiss Meditec AG and Dr. Hirnschall receives presentation fees from Carl Zeiss Meditec AG, but neither has any personal interest in the products mentioned.

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  • VIROS-Vienna Institute for Research in Ocular Surgery, Karl Landsteiner Institute, Hanusch Hospital, Vienna - Austria

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