Multi-layer internal limiting membrane plug technique for management of large full-thickness macular holes

Background To evaluate the efficacy of the multi-layer internal limiting membrane plug (MIP) technique in promoting the closure of large full-thickness macular holes (FTMH) and improvement of visual function. Methods A prospective interventional non-comparative consecutive case series including patients with surgically naïve large FTMH whether primary or secondary. All macular holes were > 400 [micro]m. All patients had 23-gauge pars plana vitrectomy (PPV), MIP technique, and sulfur hexafluoride (SF6) 20% gas tamponade. The main outcome measures were the closure of the hole, improvement of best-corrected visual acuity (BCVA), and detection of complications that might develop due to surgery. Results The study included 15 eyes of 15 patients. The mean age was 44 years (range 10-68; SD 21.5). Primary FTMH constituted 53% of cases. The mean pre-operative minimum linear diameter (MLD) was 702 [micro]m (range 401-1068 [micro]m; SD 154). The mean duration of the macular hole was 6 months (range 1-24; SD 6). The mean pre-operative BCVA was 0.06 decimal units (range 0.01-0.1; SD 0.03). Post-operatively, the macular hole was closed in all patients. U- and V- type closure developed in 93% and 7% of patients, respectively. None of the patients developed W-type closure. Post-operatively, the mean post-operative BCVA was 0.2 decimal units (range 0.05-0.5; SD 0.1). The mean improvement was 5 lines of vision. The mean postoperative follow-up period was 4 months (range 1-10; SD 2.5). None of the patients developed complications attributed to the surgical technique described. Conclusion MIP technique is effective in promoting macular hole closure and improvement of visual function in large FTMH. Keywords: Large macular holes, Secondary macular holes, Techniques for ILM peeling, ILM plug