A Successful Closure of a Large Macular Hole In Older Patient

Using the Free Internal Limiting Membrane Flap Technique: A

Case Report
Syena Damara Riza Gustam, Ramzi Amin, A.K. Ansyori

Purpose : To report a case of idiopathic macular hole in older patient managed with
pars plana vitrectomy with internal limiting membrane peeling using free flap technique.
Method : A 60-year-old female had been experiencing central vision loss in her right
eye since 2 months ago. Pre-operative visual acuity of counting fingers at 1 meter.
Baseline macular Optical Coherence Tomography showed a large full thickness macular
hole measuring 756 μm in diameter associated with chronic cystoid degenerative
changes and posterior hyaloid detachment in macula but remain attached at the edge of
optic nerve. The patient underwent pars plana vitrectomy with internal limiting
membrane peeling using free flap technique and intra ocular SF6 gas tamponade.
Furthermore, she was recommended to maintain a face-down position for a duration of
7 days.
Results : Three weeks post operative showed complete closure of the macular hole
from its initial measure (756 μm). Visual acuity improved from counting fingers at 1
meter to 6/60.
Conclusions :
Large full thickness macular hole can be effectively managed with the use of the free
internal limiting membrane flap technique. Utilizing the proper combination of pars plana
vitrectomy, flap of internal limiting membrane peeling, intraocular gas tamponade, and
postoperative positioning can lead to successful management of large and chronic
idiopathic macular hole with limited vision recovery.