title: [Step-by-step creation of internal limiting membrane fragment for surgical treatment of large idiopathic macular holes].
abstract: OBJECTIVE
  to develop a surgical procedure for large idiopathic macular holes (MH) that would involve creation of an original internal limiting membrane (ILM) flap to close the hole with.
  
  
  METHODS
  Nineteen patients aged from 59 to 71 years with stage 3 idiopathic MH (by J. Gass) were enrolled. Besides standard ophthalmic examination, spectral optical coherence tomography and microperimetry were performed in all cases. The patients were followed up 2 weeks and then 1 and 3 months after surgery. Surgical procedure was notable for an original ILM flap created in a way that resembles removing petals from a flower. The new method implies that the ILM is peeled off all the way round the MH except for the foveolar area and one particular ILM fragment, which is only partially separated from the retina, from the periphery towards the MH, stopping at some 0.1-0.2 mm from its margin. This last fragment is then inverted to cover the MH.
  
  
  RESULTS
  All surgeries were completed without complications. Visual acuity has gradually increased over the follow-up period in all patients: from 0.1-0.4 to 0.3-0.7 (0.39±0.15 on the average; Sivtsev-Golovin chart). Foveal anatomy has also improved: complete closure of the MH was achieved in 8 patients, partial - in 11. Moreover, all patients demonstrated a shift of the retinal fixation point towards the center of the fovea for 153-369 mm, at that, their fixation has stabilized and absolute central scotomas disappeared.
  
  
  CONCLUSIONS
  The method developed is a promising treatment for large idiopathic macular holes. Further studies are required.
authors.affiliation: Kaluga branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 5 Svyatoslava Fedorova St., Kaluga, Russian Federation, 248007.
authors.forename: Yu A
authors.initials: YA
authors.lastname: Belyy
authors.affiliation: Kaluga branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 5 Svyatoslava Fedorova St., Kaluga, Russian Federation, 248007.
authors.forename: A V
authors.initials: AV
authors.lastname: Tereshchenko
authors.affiliation: Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 59a Beskudnikovskiy bulvar, Moscow, Russian Federation, 127486.
authors.forename: D O
authors.initials: DO
authors.lastname: Shkvorchenko
authors.affiliation: Kaluga branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 5 Svyatoslava Fedorova St., Kaluga, Russian Federation, 248007.
authors.forename: E V
authors.initials: EV
authors.lastname: Erokhina
authors.affiliation: Kaluga branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of Russia, 5 Svyatoslava Fedorova St., Kaluga, Russian Federation, 248007.
authors.forename: N M
authors.initials: NM
authors.lastname: Shilov