title: Internal limiting membrane translocation for refractory macular holes.
abstract: Closure is more difficult to achieve in macular holes that remain open following a previous unsuccessful pars plana vitrectomy (PPV). We present our results with the internal limiting membrane (ILM) translocation technique that is used to optimise outcomes in refractory macular holes.
  
  
  
  A prospective, interventional, case series was conducted. 12 eyes of 12 consecutive patients with incomplete sealing of the macular hole (open and type 2 closure) after a previous PPV with ILM peeling were included. Measured baseline parameters included best-corrected visual acuity (BCVA) and macular hole smallest diameter, base diameter and height. Surgeries were performed by harvesting a fragment of the ILM near the vascular arcades and subsequently placing it inside the hole. Postoperative measured outcomes included macular hole status, foveal contour, outer retina integrity, BCVA and surgery-related complications.
  
  
  
  Anatomic closure occurred in 11 of 12 eyes (91%). This technique elicited a statistically significant improvement in BCVA (p=0.008). Mean BCVA was 20/400 at study baseline and 20/160 at final follow-up. However, less than 16.7% of cases had a final BCVA of ≥20/63.
  
  
  
  The ILM translocation technique seems to facilitate persistent idiopathic macular hole closure, where primary surgery with PPV and ILM peeling failed.
authors.affiliation: Department of Ophthalmology, Centro Hospitalar do Baixo Vouga, Porto, Portugal.
authors.forename: Joana
authors.identifier: 0000-0002-6864-8722
authors.initials: J
authors.lastname: Pires
authors.affiliation: Department of Ophthalmology, Centro de Oftalmología Barraquer, Barcelona, Spain.
authors.forename: Jeroni
authors.initials: J
authors.lastname: Nadal
authors.affiliation: Department of Ophthalmology, Hospital de Braga, Braga, Portugal.
authors.forename: Nuno Lourenço
authors.initials: NL
authors.lastname: Gomes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000601:surgery*; D019773:Epiretinal Membrane / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012167:Retinal Perforations / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*
keywords: Macula; Retina; Treatment Surgery; Vitreous