Inverted internal limiting membrane peeling technique with silicone oil tamponade for repair of recurrent large macular holes in vitrectomized Diabetic patients

Purpose : To present a new approach to treatment of large macular holes in already vitrectomized eyes of patients with proliferative diabetic retinopathy, whose ILM has not been removed during primary surgery. Patients and methods : Two eyes of two different patients with proliferative diabetic retinopathy which had undergone vitrectomy with endolaser 1.5 to 2 years before admittance to our department. No data for ILM peeling during surgery were available. Our OCT examinations showed macular holes with upper diameter of 765 μm in the first patient and 1160 μm in the second one. In both cases we combined two well-known surgical approaches: first, inverted ILM flap technique; second, long-term silicone oil tamponade for a period of 4 months. Results : The macula of both patients was followed up by photographs and regular OCT-s on day one, month one and three months after silicone oil removal. The macular holes remained closed after removal of the tamponade agent. BCVA was 0.5 three months after the last surgery in both patients. During the final examination, macular contour seemed almost normal. Discussion : Large, long-standing macular holes are less likely to be closed after pars plana vitrectomy. The inverted ILM flap technique has been recently reported to be successful in nearly 99% of patients with macular holes more than 400 μm in diameter. The position of the inverted ILM flap is much more controllable under silicone oil than under gas tamponade.