The Expansion of RPE Atrophy after the Inverted ILM Flap Technique for a Chronic Large Macular Hole
A 79-year-old woman presented with a chronic large MH which remained open despite pars plana vitrectomy (PPV). The surgery for the MH closure was performed twice 14 years earlier. ILM peeling was not done during previous surgeries. The best-corrected visual acuity (BCVA) with the Landolt ring chart was 0.08 at her visit. The minimum MH diameter was 1,240 μm. Inverted ILM flap technique with 20% SF6 gas tamponade was performed for the MH closure. For the inverted ILM flap technique, 25-gauge PPV and ILM staining with indocyanine green (ICG) (0.25%) were used. The ILM was peeled off for 2 disc diameters around the MH, but it was not completely removed. The ILM was then inverted and covered the MH. One week after surgery, the MH was closed, accompanied by glial cell proliferation, spreading from the inverted ILM flap (as reported before) (fig. ) []. On the other hand, the area of the submacular RPE atrophy and gliosis on the surface of the retina, which were already observed 1 week after surgery, gradually increased in size (fig. ). BCVA improved to 0.3 six months after surgery.