MANAGEMENT OF LARGE IDIOPATHIC MACULAR HOLE WITH PARS PLANA VITRECTOMY AND MODIFIED MINIMAL ILM PEELING WITH SUPERIOR ILM FLAP

Introduction: Idiopathic macular hole is an anatomic discontinuity of the neurosensory retina in center macula or fovea resulted from tractional forces on foveola at vitreoretinal interface not associated with other causes. Diagnosis and management this condition requires expertise, skills, specialized examination to detect changes which important for deciding appropriate management.
 Case Report: We report a case 66-year-old man idiopathic (IMH) right eye initial best corrected visual acuity (BCVA) 20/1200. Fundus optical coherence tomography (OCT) confirmed presence large full thickness mean linear diameter 673 µm posterior hyaloid still attached optic nerve. The patient was managed pars plana vitrectomy (PPV) surgery using modified minimal internal limiting membrane (ILM) peeling superior ILM flap SF6 gas tamponade. Two weeks after OCT showed closure hole. BCVA two four improved 20/240 20/200 respectively.
 Discussion: PPV one standardized procedures IMH surgery. Failure close late reopening initially successfully closed holes may occur without removal due role as scaffold cellular proliferation attachment contractile tissue that cause persistent vitreomacular traction. Variations such inverted has been used improve rate favorable results both anatomically functionally. Nowadays, avoid minimize damage retinal microstructure by peeling, some surgeons introduced new techniques aiming preserve IMH. Minimal technique done obtain MH less microstructural abnormalities better outcomes.
 Conclusion good terms functional outcomes.