Membrane flex loop-assisted peeling and giant flap creation for primary repair of idiopathic macular holes: a pilot study

Sep 30, 2026

Idiopathic macular holes are commonly treated with pars plana vitrectomy and internal limiting membrane (ILM) peeling, yet outcomes remain limited for large or chronic cases. This pilot study evaluates whether a FINESSE Flex Loop device can create a giant ILM flap exclusively for primary repair, aiming to reduce retinal trauma associated with forceps manipulation. In a prospective single-arm series, patients underwent 25-gauge vitrectomy with a 2–3 mm ILM flap; anatomical closure and visual gains were assessed through reoperation if needed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Keywords

Background

Jorge et al. International Journal of Retina and Vitreous (2026) 12:3 [https://doi.org/10.1186/s40942-025-00767-1](https://doi.org/10.1186/s40942-025-00767-1) International Journal of Retina and Vitreous RESEARCH Open Access Membrane flex loop-assisted peeling and giant flap creation for primary repair of idiopathic macular holes: a pilot study Rodrigo Jorge 1*†, Victor Bellanda 1,2†, Arthur S. Zupelli 1†, Moises Moura de Lucena 1, Letícia O. Audi 1, Ingrid U. Scott3 and Antonio Marcelo Barbante Casella4 Abstract Background Idiopathic macular holes are commonly treated with pars plana vitrectomy and internal limiting membrane (ILM) peeling, which achieves high closure rates in smaller holes but is less effective for large or chronic cases. Alternative techniques, such as inverted or free flaps, may improve outcomes but often involve forceps manipulation, which can damage retinal tissue. The membrane loop device (FINESSE® Flex Loop; Alcon), designed foratraumatic manipulation of the ILM, has not been evaluated for giant flap creation. This study reports the anatomical and functional outcomes of macular hole repair using a giant ILM flap created exclusively with the membrane loop. Methods This prospective, single-arm interventional case series included patients with large (minimal linear diameter > 400 μm) or chronic (≥ 6 months) idiopathic macular holes. All underwent standard 25-gauge vitrectomy with creation of a 2–3 mm ILM flap using the membrane loop without forceps. The primary endpoint was anatomical closure at day 14. Secondary outcomes included change in best-corrected visual acuity (ETDRS letters), proportion of eyes gaining ≥ 15 letters, and need for reoperation over six months. Results Eight eyes from eight patients (median age, 69 years; range, 45–77) were enrolled. Baseline median minimal linear diameter was 400 μm, and median symptom duration was 11 months. Six of eight holes (75%) were closed after primary surgery, although one recurred after two months. The two eyes that were refractory and the one that recurred subsequently achieved closure after reoperation, resulting in a final closure rate of 100% at six months. Median visual acuity improved from 20 to 55 letters, corresponding to a gain of 33 letters (95% CI, + 5 to + 48; P = 0 . 018) . Six eyes (75%) gained at least 15 letters, and no intraoperative or postoperative complications occurred. Conclusions Membrane loop-assisted giant ILM flap creation yielded a 75% primary and 100% final macular hole closure rate after reoperation, with consistent visual improvement in this pilot series of patients with large or chronic idiopathic macular holes. By minimizing retinal trauma and eliminating the need for forceps, this technique may represent a safe and effective surgical alternative. Larger, comparative studies are warranted to confirm these †Rodrigo Jorge, Victor Bellanda and Arthur Zupelli contributed equally to this work. *Correspondence: Rodrigo Jorge [rjorge@fmrp.usp.br](rjorge@fmrp.usp.br) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/

FAQs

What is the main clinical challenge addressed in this pilot study?

Large or chronic idiopathic macular holes are less responsive to conventional ILM peeling, prompting the need for alternative flap-based repair strategies.

How was the ILM giant flap created in the study?

All patients received standard 25-gauge vitrectomy with a 2–3 mm ILM flap created using the membrane loop without forceps.

What were the key outcomes for macular hole closure and vision?

Primary closure occurred in 75% of eyes, and after reoperation the final closure rate reached 100% at six months, alongside a median visual acuity improvement from 20 to 55 ETDRS letters.

Sep 30, 2026

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