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 µm. 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 µm (range 401-1068 µm; 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.