Macular Hole Closure by Internal Limiting Membrane Flap without Gas Tamponade versus Conventional Surgery: A Comparative Study

Simon K H Szeto; Julia T W Lam; Amy H Y Yu; Christopher Pang; Timothy P H Lin; Vivian W K Hui; Ken K Tsang; Jason C K Chan; Li Jia Chen; Timothy Y Y Lai; Shaheeda Mohamed; Chi Wai Tsang

doi:10.1016/j.oret.2025.06.005

Macular Hole Closure by Internal Limiting Membrane Flap without Gas Tamponade versus Conventional Surgery: A Comparative Study

Ophthalmol Retina. 2025 Jun 13:S2468-6530(25)00276-3. doi: 10.1016/j.oret.2025.06.005. Online ahead of print.

Authors

Affiliations

¹ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China; Pao So Kok Macular Disease Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chines University of Hong Kong, Hong Kong SAR, China. Electronic address: simonkhszeto@cuhk.edu.hk.
² Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China.
³ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China.
⁴ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.

PMID: 40518116
DOI: 10.1016/j.oret.2025.06.005

Abstract

Purpose: To compare the effectiveness and safety of the novel internal limiting membrane (ILM) flap with no gas tamponade technique and conventional surgery in repairing macular hole (MH).

Design: Retrospective comparative study.

Participants: Consecutive patients with optical coherence tomography (OCT) confirmed full thickness MH who underwent MH repair surgery by either conventional surgery or the ILM flap with no gas tamponade technique at the Hong Kong Eye Hospital from 1^st November 2021 to 31^st July 2024.

Methods: Medical records were reviewed for demographics, peri-operative clinical features, operative details and OCT features.

Main outcomes and measures: Primary outcome was the rate of MH closure by postoperative month 3. Secondary outcomes included postoperative logMAR visual acuity (VA) and OCT features, such as rate of foveal gliosis, dissociated optic nerve fiber layer (DONFL) score, integrity of external limiting membrane (ELM) and ellipsoid zone (EZ), and MH closure pattern.

Results: Ninety-three eyes from 93 patients were included in the study, of which 51 eyes underwent MH repair with conventional surgery and 42 underwent the ILM flap with no gas tamponade technique. The MH closure rates were comparably high in both groups (94.1% vs 95.2%, p=0.812). VA was significantly better in the no gas tamponade group at postoperative week 1 (1.48 vs 0.84, p<0.001) and month 1 (0.87 vs 0.73, p=0.048). There were no significant differences in VA by postoperative month 3 (0.54 vs 0.56, p=0.281) and 6 (0.41 vs 0.47, p=0.991). The rate of foveal gliosis was lower in the no gas tamponade group (20.0% vs 4.9%, p=0.043) in multivariate analysis. The MH closure pattern, DONFL score and ELM/EZ integrity were similar between the two groups in multi-variate analysis.

Conclusion: The ILM flap with no gas tamponade technique could achieve a high MH closure rate comparable to conventional surgery. This novel technique was associated with significantly better vision in the first month of postoperative period, as well as lower rate of foveal gliosis. These results demonstrated the feasibility of repairing MH without gas tamponade and warrant further prospective study.