title: INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MACULAR HOLE SURGERY WITHOUT EXTRA MANIPULATION OF THE FLAP.
abstract: OBJECTIVE
  To determine whether surgical manipulation steps of the internal limiting membrane (ILM) flap, such as ILM trimmed, ILM tuck inside the hole, ILM massage, are mandatory to obtain satisfactory outcomes for the repair of large stage IV idiopathic macular hole using the inverted ILM flap technique.
  
  
  METHODS
  In this interventional comparative prospective single-masked study, 81 eyes were randomized into 2 treatments groups. In Group 1 (41 eyes), the classic inverted ILM flap technique was performed. In Group 2 (40 eyes), a modified procedure was used: after ILM peeling, no extra flap manipulation was performed. The macular hole was covered by the inverted ILM flap because of the air pressure at the time of the fluid-air exchange.
  
  
  RESULTS
  At 12 months, macular hole closure was observed in 40 eyes (97.6%) in Group 1 and in 39 eyes in Group 2 (97.5%). U-shape closure rate, ellipsoid zone defects, and external limiting membrane defects were similar in both groups. The results indicate no statistical difference in anatomical and functional success between both groups.
  
  
  CONCLUSIONS
  The macular hole closure rate, improved visual acuity, and no extra complications indicate noninferiority of the modified inverted ILM technique. Internal limiting membrane finishing, tucking, and massage may not be required to obtain surgical success.
authors.affiliation: *Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy; †The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. The King Khaled Eye Specialist Hospital, Retina Division, Riyadh, Kingdom of Saudi Arabia; ‡Eye Clinic, University of Cagliari, Cagliari, Italy; and §Department of Health Sciences, Eye Clinic, University of Piemonte Orientale, Novara, Italy.
authors.forename: Giamberto
authors.initials: G
authors.lastname: Casini
authors.forename: Marco
authors.initials: M
authors.lastname: Mura
authors.forename: Michele
authors.initials: M
authors.lastname: Figus
authors.forename: Pasquale
authors.initials: P
authors.lastname: Loiudice
authors.forename: Enrico
authors.initials: E
authors.lastname: Peiretti
authors.forename: Stefano
authors.initials: S
authors.lastname: De Cillà
authors.forename: Taiusha
authors.initials: T
authors.lastname: Fuentes
authors.forename: Francesco
authors.initials: F
authors.lastname: Nasini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery*; D016037:Single-Blind Method; D013524:Surgical Flaps; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*