The Flip and Fix internal limiting flap technique versus the classic temporal flap for macular hole repair

Abstract Purpose: To describe a novel technique of macular hole (MH) repair and compare it to the perfluorocarbon liquid (PFCL)-assisted temporal internal limiting membrane (ILM) flap technique. Methods: Twenty-two eyes of 22 patients with MH were randomized on a 1:1 basis into two groups. Group A cases were treated using the Flip and Fix technique, in which the single-layer ILM flap was flipped, flattened over the macula using PFCL, and fixed in place using two drops of autologous nonheparinized blood over the superonasal and inferonasal edges of the flap (away from the MH center). Group B patients had the classic temporal ILM flap technique without using the PFCL or autologous blood. All patients were followed up for a period of 6 months after the surgery. Results: No significant difference was observed in initial and final visual acuities between Groups A and B. Intraoperative flap displacement did not occur in Group A and occurred in two eyes in Group B (18.2%). One of them showed failed MH closure and required reoperation. These two cases had a final (W shape) MH closure and a worse final vision than the remaining cases, which had either a U shape or V shape final MH closure. Conclusions: The study results show that the Flip and Fix technique is as effective as the PFCL-assisted temporal ILM flap technique and is associated with less ILM flap displacement risk for the repair of macular holes.