Macular hole closure with a vertical joint of the inner limiting membrane (ILM)

This case report describes an unexpected surgical outcome with the presence of a vertical joint of the inner limiting membrane (ILM) after a vitrectomy using the inverted internal limiting membrane flap technique. A woman presented with 5 months of vision loss in the left eye. The visual acuities were 6/9 in the right eye and 6/75 in the left eye. Examination revealed a large macular hole (MH). After vitrectomy with an inverted ILM flap technique using 14% C3F8 as endo tamponade, the MH was closed with a vertical ILM joint detected. A second operation was performed to remove the ILM without significantly improving vision. We present a non-previously described situation of forming a vertical standing joint ILM related to the surgical choice of inverted ILM flap technique. Our findings suggest that the presence of ILM is not clinically relevant in vision or scotoma.