PMC7507815_01
Optical coherence tomography of the right eye before surgery showing Full thickness macular hole (a). Five months after surgery, there was closure of the macular hole (b). Note the restructuring of the photoreceptor layer of the retina. In foveal center, there was partial restructuring of the external limiting membrane (ELM) layer, but no restoration of the ellipsoid zone layer
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Fig1
Eye fundus examination revealed a grade 4 macular hole (MH) according to Gass, confirmed by OCT, which showed a full thickness MH with a minimum linear diameter of 748 mum and a height of 368 mum (Fig. 1a). Five months after the intervention, the patient showed BCVA of 1.0 logMAR (20/200 snellen) in OD, with full MH closure detected by fundoscopy and OCT (Fig. 1b).
Pedicle internal limiting membrane flap technique. a ILM peeling starts inferiorly to the macular hole (surgeon view); b the ILM is carefully dissected around the macular hole; c The ILM flap remains attached to the temporal macular hole edge and is trimmed with the vitrectomy probe using the scissors mode
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Fig2
The following procedures were performed: prophylactic 360  laser in OD, pars plana vitrectomy, ILM peeling with confection of an inverted pedicle ILM flap of OD followed by fluid air exchange and 13% C3F8 infusion. (Fig. 2a-c).
PMC7507815_02
Optical coherence tomography of the right eye before surgery showing a full thickness macular hole with intraretinal cysts (a) and macular hole closure 6 months after surgery (b). Note the restructuring of the photoreceptor layer of the retina. In foveal center, there was partial restoration of the external limiting membrane (ELM) and ellipsoid zone layers
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Fig3
OD. OCT showed a full thickness MH with a minimum linear diameter of 811 mum and height of 444 mum (Fig. 3a). Six months after the procedure, the patient showed BCVA of 0.9 logMAR (20/160 snellen) in OD, with fundoscopy and OCT revealing full MH closure (Fig. 3b).
PMC7507815_03
Color fundus picture and optical coherence tomography (OCT) of the right eye before surgery, showing a large macular hole (a-b). Five months after surgery, the macular hole was closed (c). In foveal center, no restoration of the external limiting membrane (ELM) and ellipsoid zone layers was verified
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Fig4
OD (Fig. 4a). OCT showed a full thickness MH with a minimum linear diameter of 768 mum and a height of 388 mum (Fig. 4b). Five months after the procedure, the patient had BCVA of 1.0 logMAR (20/200 snellen) in OD, with full MH closure determined by fundoscopy and OCT (Fig. 4c).
PMC7507815_04
Color fundus picture and optical coherence tomography (OCT) before surgery, showing large macular hole (a, b). Six months after surgery, MH with dimensions similar to baseline values (c)
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Fig5
OD. OCT showed a full thickness MH with a minimum linear diameter of 755 mum and a height of 483 mum (Fig. 5a, b). Five months after the procedure, the patient had maintained BCVA of 1.2 logMAR (20/320 snellen) in OD and a maintained MH of width and thickness similar to baseline values (Fig. 5c).