Comparison of the results of cases that applied classical surgery and temporal reverse internal limiting membrane flap technique due to idiopathic macular hole

Purpose: Comparison of the anatomical and functional results of classical surgery and temporal reverse internal limiting membrane (ILM) flap technique for cases that underwent vitreoretinal surgery due to idiopathic macular hole (MH). Material-method: 47 eyes of 47 patients who underwent vitreoretinal surgery (VRC) because of MH at the Department of Ophthalmology of Tokat Gaziosmanpaşa University Faculty of Medicine Hospital between June 2020 and March 2024 were included in the study. After general ophthalmological inspection, MH anatomical parameters which are determined by optical coherence tomography (OCT), gender distribution of patients, side eye, age, MH staging, best corrected visual acuity (BCVA) were recorded. The surgical technique applied to the patients, BCVA in the postoperative period, follow-up period of the patients, recurrence, anatomical and functional success rates were examined. Classical surgery was performed on patients with MH of 400 μm or less, and temporal reverse ILM flap technique was performed on patients with MH of 400 μm or greater in the study. Patients who are applied classical surgery were classified as group 1, and patients who are applied temporal reverse ILM flap technique were classified as group 2. Post-VRC checks of the patients were performed at 1st week, 1st month, 3rd month, and then at 6-month intervals. Patients' visual acuity and the number of months they were followed up were noted. Findings: The distribution of patients included in the study is 16 males (34%) and 31 females (66%). The average follow-up period of the patients was 6.09±8.22 months. A significant difference was found between the two groups preoperative (p<0.001) visual acuity. Hovewer, no statistically significant difference was found between the postoperative 1st week (p=0.051), postoperative 1st month (p=0.197) and final visual acuity (p=0.241) at their latest follow-ups. In the postoperative period, MHs of 45 patients (95.7%) closed and 2 patients (4.3%) did not close. In Group 1, macular holes closed in 20 patients (90.9%) and did not close in 2 patients (9.1%). Two patients whose MH did not close did not apply a second surgery because they had widespread RPE atrophy in their fovea. Macular holes closed in 23 (92%) patients in Group 2. In 2 (8%) patients, it was observed that the MH did not close due to ILM flap dislocation. Second surgery applied to these two patients and achieved complete closure. The success rate increased to 100% after the second surgery in Group 2. Results: In the study, it was observed that there was a significant increase in postoperative best corrected visual acuity with both techniques applied for macular hole surgery and these the two techniques were not superior to each other in appropriate patients. High anatomical success rates have been observed with both techniques. In conclusion, with appropriate patient selection, successful results can be achieved with both surgical techniques. Keywords: Macular hole, vitreoretinal surgery, optical coherence tomography, internal limiting membrane