New Surgical Instrument for Autologous Internal Limiting Membrane Transplantation for the Treatment of Refractory Macular Holes

Macular hole (MH) diameter has a strong influence on postoperative anatomical and functional results. The inverted internal limiting membrane (ILM) flap technique improves anatomical and functional outcomes of vitrectomy for large MHs with a minimum diameter exceeding 500 mm.1 However, improvements in these procedures have not resulted in 100% satisfactory surgical outcomes. In some cases of idiopathic MHs, initial surgery using the inverted ILM flap technique fails to achieve MH closure, while the ILM has been previously removed in others. In such cases with refractory MHs, Morizane reported that autologous transplantation of the ILM resulted in a success rate of 90%.2 However, it is often difficult to harvest and place a suitably sized free ILM flap into the MH,3 and the procedure is relatively invasive to the retinal pigment epithelium and neural retina. To address this issue, we developed a new instrument that can harvest and push the free ILM flap safely and reliably into the MH.