title: TEMPORAL INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR A MACULAR HOLE PATIENT UNABLE TO MAINTAIN POSTOPERATIVE PRONE POSITIONING.
abstract: OBJECTIVE
  To report the surgical technique and efficacy of the temporal inverted internal limiting membrane (ILM) flap technique for a patient with an idiopathic macular hole (MH) who is unable to maintain postoperative prone positioning.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 73-year-old man with a Stage III MH in his left eye was scheduled to undergo surgery. Owing to his inability to maintain postoperative prone positioning for continuous placement of a transdermal bladder catheter after radical cystoprostatectomy to treat urinary bladder cancer, he underwent pars plana vitrectomy combined with the temporal inverted ILM flap technique and intraocular sulfur hexafluoride gas tamponade. The technique included ILM peeling at a temporal area of the macula to create one 2-disk-diameter semicircular ILM flap and inversion of the ILM flap nasally to cover the MH. Optical coherence tomography showed that MH closure started from the top of the MH just beneath the covered ILM flap; the closure process gradually extended toward the bottom of the MH. The well-aligned fovea recovered in 5 weeks postoperatively. The visual acuity was 20/200 preoperatively and improved to 20/50 postoperatively.
  
  
  CONCLUSIONS
  The temporal inverted ILM flap technique, a simple surgery to treat MHs, provides scaffolding for retinal gliosis and may facilitate bridge formation between the walls of the MH beneath the flap. The procedure may be a good option to achieve MH closure without postoperative prone positioning.
authors.affiliation: *Department of Ophthalmology, Shimane University, Izumo, Japan; and †Division of Ophthalmology, Matsue Red Cross Hospital, Matsue, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Takai
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanito
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Sugihara
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kodama
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ohira
mesh_terms: D000368:Aged; D019773:Epiretinal Membrane / Q000601:surgery*; D006801:Humans; D008266:Macula Lutea / Q000601:surgery*; D008297:Male; D056888:Patient Positioning; D011184:Postoperative Period; D016684:Prone Position; D012167:Retinal Perforations / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014821:Vitrectomy / Q000379:methods*