Impact of the Inverted Internal Limiting Membrane Flap Diameter on Large Idiopathic Macular Hole Closure: Comparative Randomized Study

BACKGROUND AND OBJECTIVE: To study the impact of the size of internal limiting membrane inverted flap on the rate and timing of large idiopathic macular hole (MH) closure. PATIENTS AND METHODS: A prospective randomized comparative study included patients with large idiopathic MH. Eligible eyes underwent pars plana vitrectomy with either inverted small flap ( SF < 2 disc diameters) or inverted large flap (LF from 2 to 4 disc diameters). The primary outcome measure included the rate of MH closure at the sixth month. Secondary outcome measures included the timing of MH closure and best-corrected visual acuity. RESULTS: Twenty-five eyes were included: 13 in the SF group and 12 in the LF group. At 6 months, the rate of closure was 84.6% in the SF group and 91.6% in the LF group, with no significant difference. Timing of closure was significantly shorter with LF, with better postoperative best-corrected visual acuity. CONCLUSION: LF offered a shorter duration for closure with better visual outcomes in large idiopathic MH. [ Ophthalmic Surg Lasers Imaging Retina . 2022;53:103–107.]