OUTCOMES OF A NOVEL TECHNIQUE THAT DOES NOT REQUIRE HEAD POSITION IN MACULAR HOLE SURGERY: Application of Viscoelastic on an Inverted Internal Limiting Membrane Flap Under Air.

Abstract

To report outcomes of a novel technique involving the injection of a dispersive viscoelastic device on to inverted temporal internal limiting membrane flap under air for macular hole (MH) closure, without requiring postoperative head positioning. A temporal internal limiting membrane flap was created in all patients and inverted over the MH with perfluorocarbon liquid. After a fluid-air exchange, a perfluorocarbon liquid-air exchange was done. Afterward, a dispersive viscoelastic agent was applied around the inverted flap under air, covering an area of two-to-three-disk diameters. An air-sulfur hexafluoride exchange was then performed, and the sclerotomies were closed. No head positioning was advised postoperatively. Data on preoperative MH size, best-corrected visual acuity, MH closure rate, and closure pattern were collected. The study included 114 eyes from 106 patients. Initial MH closure was achieved in 112 eyes (98.2%), with two cases closed after a second surgery. U-shaped closure occurred in 71.9%, V-shaped in 20.1%, and W-shaped in 8%. Significant best-corrected visual acuity improvement was observed ( P < 0.001), with no significant change in intraocular pressure ( P = 0.881). This technique enhances flap stabilization, facilitates MH closure, and eliminates the need for postoperative head positioning, leading to favorable anatomical and functional outcomes with improved patient comfort.