Temporal inverted internal limiting membrane flap technique for a 500 μm full-thickness macular hole: A case report

Rationale

Large full-thickness macular holes (FTMH), defined by the International Vitreomacular Traction Study Group as defects of all retinal layers within the foveal region with an aperture size of 400 μm or more, remain a challenging condition with reduced anatomical closure rates using conventional techniques. We report a case managed with the temporal inverted internal limiting membrane (ILM) flap technique. Patient concerns: A 70-year-old female patient presented to the Outpatient Ophthalmology Clinic with decreased vision in the left eye. Diagnoses: Decimal Snellen best-corrected visual acuity was 0.3 (5/16) in oculus sinister (left eye) and 0.06 (3/50) in oculus dexter (right eye), and intraocular pressure was 16 mm Hg in both eyes. Optical coherence tomography (OCT) revealed an hourglass-shaped FTMH with cystic changes within the retina and rounded thickened edges, with a minimum aperture size of 500 μm. Fundus examination and OCT of the fellow (right) eye also revealed a full-thickness macular hole (MH), with a smaller aperture than the left eye.