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Large full-thickness macular holes remain challenging because standard vitrectomy with internal limiting membrane peeling can have lower anatomical success than it does in smaller holes. This prospective randomized trial compared conventional ILM peeling with an inverted ILM flap technique in holes measuring 600 to 1500 micrometres. Anatomical closure was numerically higher with the inverted flap, although the difference did not reach statistical significance, and visual outcomes were broadly similar. The study therefore supports the inverted-flap concept as a reasonable option for large holes while highlighting the limits of a small sample. For HCPs, the clinical decision should consider hole size, chronicity, myopia, posterior segment anatomy and the surgeon's familiarity with the technique. The trial also illustrates why anatomical closure and visual recovery should be discussed separately with patients: even successful closure may not produce normal central vision. This evidence fits AIOC's retina focus on macular hole closure strategies and advanced micro-incisional vitrectomy techniques.
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Large full-thickness macular holes remain challenging because standard vitrectomy with internal limiting membrane peeling can have lower anatomical success than it does in smaller holes. This prospective randomized trial compared conventional ILM peeling with an inverted ILM flap technique in holes measuring 600 to 1500 micrometres. Anatomical closure was numerically higher with the inverted flap, although the difference did not reach statistical significance, and visual outcomes were broadly similar. The study therefore supports the inverted-flap concept as a reasonable option for large holes while highlighting the limits of a small sample. For HCPs, the clinical decision should consider hole size, chronicity, myopia, posterior segment anatomy and the surgeon's familiarity with the technique. The trial also illustrates why anatomical closure and visual recovery should be discussed separately with patients: even successful closure may not produce normal central vision. This evidence fits AIOC's retina focus on macular hole closure strategies and advanced micro-incisional vitrectomy techniques.
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