Autologous Blood as Adjuvant in Inverted ILM Flap Surgery for Idiopathic Macular Hole: Case Series

Purpose: To evaluate the use of autologous blood as an adjuvant in the surgical treatment of idiopathic macular hole (IMH) associated with the inverted internal limiting membrane (ILM) flap technique and gas tamponade. Methods: Fourteen patients with stage IV idiopathic macular hole and a diameter equal to or greater than 400 μm were retrospectively evaluated. All patients underwent 23-gauge pars plana vitrectomy, ILM peeling with centripetal inverted flap technique, application of autologous blood over the folded ILM flap inside the hole, and tamponade with an air-SF6 (20%) mixture. Patients were instructed to maintain a prone position for 5 days. Results: Anatomical closure was achieved in all cases. The mean minimum macular hole diameter was 528 μm. The mean best-corrected visual acuity (BCVA) improved from 20/118 (0.77 logMAR units) preoperatively to 20/46 (0.36 logMAR units) postoperatively (p < 0.01). Patients with hole diameters between 400–500 μm improved by 3–4 ETDRS lines, while those with holes >500 μm improved by 1–2 ETDRS lines. The mean follow-up duration was 13.2 months (range: 12–24 months). Only one patient developed mild retinal pigment epithelium (RPE) toxicity related to dye and light exposure. Conclusions: Autologous blood, used as a sealing plug to stabilize the ILM flap over the macular hole and as a reservoir of growth factors, proved to be an effective adjuvant in promoting anatomical closure in idiopathic macular hole surgery.