Comparison Between Outcomes of Closure of Idiopathic Macular Hole Using Autologus Tenon Capsule Graft and Internal Limiting Membrane Flap Techniques (Pilot Study)

Macular hole (MH) is a full-thickness defect of the neurosensory retina at the fovea, causing central visual loss. The incidence of idiopathic MH increases with age and is more common in females. Vitreomacular traction is the main pathophysiological factor leading to MH formation.

Pars plana vitrectomy with internal limiting membrane (ILM) peeling has been considered the standard technique for MH repair, achieving high anatomical closure rates. However, for large and refractory holes, conventional ILM peeling may not be sufficient.

The inverted ILM flap technique was developed as an alternative for large MHs (≥400 µm). This method allows the peeled ILM to be inverted and placed over the hole to serve as a scaffold for glial proliferation, enhancing closure rates and improving visual outcomes.

More recently, Tenon capsule graft has been introduced as an autologous biological scaffold for macular hole closure. Tenon tissue is rich in fibroblasts and extracellular matrix, which may promote retinal repair and facilitate closure in cases resistant to conventional approaches.

Optical coherence tomography (OCT) has become essential for evaluating macular hole dimensions, classifying stages, and confirming closure after surgery. It provides high-resolution images that allow detailed morphologic analysis.