AIM:To compare the effectiveness of inverted internal limiting membrane flap(ILMF)coverage combined with sterile air tamponade or C₃F₈-filled surgery for idiopathic macular hole(IMH).

METHODS: In this retrospective study, 165 patients(175 eyes)who underwent pars plana vitrectomy(PPV)combined with inverted ILMF coverage were evaluated. The surgeries were performed by one surgeon at the Renmin Hospital, Wuhan University between January 2014 and June 2017. The patients were divided into sterile air(Group A)and C₃F₈-filled(Group B)groups, based on the technique used for intraocular tamponade. With a minimum 3-month follow-up, pre- and post-operative best corrected visual acuity(BCVA), macular hole closure rate, and major postoperative complications were analyzed.

RESULTS: Both groups showed significant improvement in visual acuity at 1 and 3mo postoperatively(P<0.05). There was no significant difference between the two groups 1mo postoperatively, but the average BCVA in Group A was better than that in Group B at 3mo, to a level of statistical significance(P<0.05). The closure rate of macular hole was 97.5% in Group A and 96.8% in Group B, a statistically non-significant difference. There were no statistically significant differences in defect diameters of the inner and outer junctions between the two groups at 1 and 3mo postoperatively(P<0.05), but significant differences compared to before surgery in both groups(P<0.05). The rate of IOP elevation was 9.5% in Group B, and zero(0)in Group A; this difference was statistically significant(P<0.05).

CONCLUSION: We postulate that PPV combined with inverted ILM flap is a safe and effective method for surgical management of IMH. Compared to C₃F₈-filling, sterile air tamponade can avoid IOP elevation; it may replace C₃F₈-filling in PPV for IMH.