The Cloverleaf Internal Limiting Membrane Flap Technique for Repair of Challenging Macular Holes.

Purpose: This study introduces the Cloverleaf Internal Limiting Membrane (ILM) flap technique for managing challenging macular holes, aiming to enhance ILM flap placement and improve functional and anatomical outcomes.

Methods: A retrospective review of cases undergoing the Cloverleaf ILM flap technique was conducted at a single center. This technique involves creating multiple ILM flaps in a cloverleaf configuration in order to enhance the stability and coverage of the macular hole. Clinical characteristics, surgical details, and outcomes were analyzed. Visual acuity measurements were converted to logMAR values.

Results: The study included 29 eyes of 29 patients with a mean age of 65.3 years, and 58.6% females. Macular hole aperture and base sizes were 423.7 (± 264.9) µm and 1,017.5 (± 229.0) µm, respectively. Preoperatively, 62.1% of cases were phakic and 37.9% were pseudophakic. The median duration of symptoms was 90 (IQR: 60-300) days, with surgery performed approximately 34 (IQR: 28-69) days after presentation. Anatomical closure was achieved in 93.1% of cases. Patients had a mean 4.5 (± 4.4) Snellen lines of improvement in their visual acuity. The median duration of follow-up was 118 (IQR: 36-1,491) days.

Conclusions: The Cloverleaf ILM flap technique may serve as a promising approach for challenging macular holes. By creating a cloverleaf configuration of quadratic ILM flaps folded over the MH, this technique enhances flap stability, potentially improving macular hole closure success.