Comparative visual outcomes of inverted ILM flap “covering” versus “stuffed” techniques for macular hole surgery

PURPOSE: To compare the functional and anatomical outcomes of the inverted internal limiting membrane (ILM) flap covering and stuffed techniques in primary macular hole (MH) surgery. METHODS: This retrospective case series included 57 eyes that underwent inverted ILM flap surgery by a single surgeon (covering, n = 33; stuffed, n = 24). Best-corrected visual acuity (BCVA) and optical coherence tomography findings, including restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ), were assessed preoperatively and at 1 and 6 months postoperatively. RESULTS: There were no significant differences in preoperative characteristics or MH closure rates between groups. BCVA improved significantly in both groups postoperatively; however, BCVA was significantly better in the covering group at 1 month (P = 0.005) and 6 months (P = 0.001). Restoration of the ELM and EZ was more frequent in the covering group at 1 month (ELM, P < 0.001; EZ, P = 0.002) and 6 months (ELM, P < 0.001; EZ, P = 0.001). CONCLUSION: Although both techniques achieved comparable anatomical closure, the covering method provided superior visual and outer retinal recovery for a wide range of macular holes, including medium-to-large cases. These findings suggest that the covering technique may be preferable as a standard approach for primary MH surgery.