Purpose. To evaluate the efficacy of internal limiting membrane (ILM) peeling combined with modified flap inverting under air in the treatment of large idiopathic macular hole (MH). Methods. Eyes with a large idiopathic MH (minimum diameter >550 μm) were included in this study. The surgical procedure included standard 23-gauge pars plana vitrectomy (PPV), ILM peeling, complete fluid-gas exchange, and ILM flap inversion under air. The patients underwent follow-up exam including optical coherence tomography (OCT) and best-corrected visual acuity (BCVA) measurement. Results. Sixteen eyes from 16 patients were included. Mean MH diameter was 681.43 ± 112.12 μm. After a mean follow-up time of 6.25 ± 2.65 months, in all cases, the MH was closed, and the ILM flap could be seen at the inner surface of the fovea. U-shaped and V-shaped MH closure was achieved in 11 and 5 cases, respectively. The BCVA improved significantly from 1.49 ± 0.35 logMAR to 0.89 ± 0.35 logMAR (), and visual acuity of 20/100 or better was achieved in 8 eyes. Conclusion. ILM flap inverting under air was helpful in improving the functional and anatomic outcomes of vitrectomy for large idiopathic MH.

中文翻译：

---

特发性大黄斑裂孔手术中的内界膜剥离和空气下翻瓣

目的。评价内界膜（ILM）剥离联合改良空气下翻瓣治疗特发性大黄斑裂孔（MH）的疗效。方法。本研究包括具有大特发性MH（最小直径> 550μm  ）的眼睛。手术过程包括标准的 23 号玻璃体切除术 (PPV)、ILM 剥离、完全液气交换和空气下 ILM 皮瓣翻转。患者接受了包括光学相干断层扫描（OCT）和最佳矫正视力（BCVA）测量在内的随访检查。结果。包括来自 16 名患者的 16 只眼睛。平均 MH 直径为 681.43 ± 112.12  μ米。平均随访时间为 6.25 ± 2.65 个月后，所有病例均关闭 MH，在中央凹内表面可见 ILM 皮瓣。分别有 11 例和 5 例实现 U 形和 V 形 MH 闭合。BCVA 从 1.49 ± 0.35 logMAR 显着提高到 0.89 ± 0.35 logMAR ()， 8 只眼的视力达到 20/100 或更高。结论。空气下 ILM 皮瓣倒置有助于改善大型特发性 MH 玻璃体切除术的功能和解剖结果。