COMBINED 41-GAUGE SURGICALLY INDUCED MACULAR DETACHMENT AND FREE INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR MANAGEMENT OF REFRACTORY FULL-THICKNESS MACULAR HOLE.

Purpose: The objective of this study was to report a case of anatomic closure and functional improvement in a patient affected by refractory full-thickness macular hole who underwent a combined 41-gauge (g) surgically induced macular detachment and free internal limiting membrane flap technique.

Methods: This is a retrospective case report of a 70-year-old woman affected by refractory full-thickness macular hole who referred to the Ophthalmology Unit of Guglielmo da Saliceto Hospital, Piacenza (Italy), in April 2023. The patient underwent a combined 41-g surgically induced macular detachment and free internal limiting membrane flap technique. Macular detachment was induced by multiple subretinal injections of balanced salt solution by 41-g needle through three retinotomies. Spectral domain optical coherence tomography and best-corrected visual acuity were performed preoperatively and postoperatively at the seventh day and at the first and sixth month.

Results: On the seventh postoperative day, full-thickness macular hole showed complete closure. Best-corrected visual acuity improved from preoperative 20/400 to 20/70 at the sixth postoperative month.

Conclusion: Balanced salt solution subretinal injection allowed the mobilization and relaxation of retina at the posterior pole. Although the edges of the hole were still detectable, their diameters were inferior to preoperative measurements. Autologous free internal limiting membrane flap allowed to fill the residual gap into the hole. The final anatomic closure and the postoperative functional improvement demonstrated the effectiveness of this approach, supporting its indication for refractory FTHM.