title: Macular hole surgery in a patient who cannot maintain facedown positioning.
abstract: OBJECTIVE
  To present macular hole surgery in a patient who had previously undergone thyroid removal surgery.
  
  
  METHODS
  During thyroid gland removal surgery, the recurrent laryngeal nerves were cut by the surgeon. Therefore, the patient had to have a tracheotomy and because of this unusual situation, the patient could not breathe if lying 'upside-down'. Complete ophthalmic examination and spectral optical coherence tomography was performed in a 77-year-old woman before and after macular hole surgery.
  
  
  RESULTS
  The patient was treated by the 'inverted internal limiting membrane (ILM) flap technique' with air tamponade for macular hole closure. This technique was described to have very high success rates in large, stage IV macular holes. Postoperatively, lying on her opposite side was advised. However, the macular hole remained open after this approach. Because of this, another approach was undertaken. The ILM flap technique and silicone oil were applied, and the patient was positioned on her opposite side. Silicone oil was removed after 3 months. Eighteen months later, the macular hole remained closed. Visual acuity improved from 10/200 to 20/50.
  
  
  CONCLUSIONS
  This case demonstrates that in an extremely select group of patients, silicone oil combined with the inverted flap technique may be considered for treatment of macular hole.
authors: Ophthalmic Clinic 'Jasne Blonia', Lodz, Poland.
authors: Zofia
authors: Z
authors: Michalewska
authors: Jerzy
authors: J
authors: Nawrocki
keywords: Inverted ILM flap; Macular hole; SD-OCT