Macular hole reopening after inverted internal limiting membrane flap


 Introduction: Here, we present a case of macular hole (MH) reopening after an initial successful closure with an inverted internal limiting membrane (ILM) flap procedure.

 Case Report: The patient was a 72-year-old Hispanic male who presented with decreased vision in the right eye who was found to have a 431 μm, full-thickness macular hole. The patient underwent three separate 25-gauge pars plana vitrectomies to correct the macular hole. The first involved an inverted ILM flap technique, the second one removal of the flap and the third one subretinal injection of balanced salt solution (BSS).

 Conclusion: The failure of the inverted ILM flap, we believe, was primarily due to the inferiorly attached flap being pulled down by surface tension of the rising fluid level.
