Modified ILM flap technique for macular hole

Background: Currently, vitrectomy is considered as the first line of treatment in the management of macular holes. Various surgical modalities have been described to obtain anatomical closure. However, there are still challenges when the hole is large and chronic (>400 microns) in nature. Here we describe a modified technique of internal limiting membrane (ILM) peeling which results in the successful closure of such macular holes. Purpose: To demonstrate modified ILM flap techniques in management of chronic macular holes. Synopsis: Here we have described the role of modified ILM peeling techniques in three different cases such as chronic traumatic macular hole >400 microns, chronic idiopathic macular hole >400 microns and <400 microns. Highlights: This modified ILM flap technique provides the benefit of an inverted ILM flap, which helps in glial proliferation and also relives tangential traction thereby aiding in successful macular hole closure in chronic cases. Video link: https://youtu.be/RKVLd1mSw08.