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A prospective cohort study involved patients with large IMH (>400 μm), using ILM dissection and a pedicled ILM flap rotated positively to cover the defect. Outcomes included best-corrected visual acuity (BCVA), SD-OCT structural indices, and metamorphopsia assessed by M-CHARTS, with additional SEM analysis of peeled ILM. All cases achieved IMH closure, with significant BCVA improvement and reduced ellipsoid zone and external limiting membrane defects.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/positive-rotational-internal-limiting-membrane-covering-technique-for-large-idiopathic-macular-holes/444261/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/positive-rotational-internal-limiting-membrane-covering-technique-for-large-idiopathic-macular-holes/444261.png","ImageObject",300,407,{"name":92,"@type":93},"Cart","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-01","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the purpose of the positive rotational ILM covering technique?","Question",{"text":112,"@type":113},"The study aims to determine the efficacy of a modified technique using positive rotational ILM covering for treating large idiopathic macular holes.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was the ILM flap prepared and used during surgery?",{"text":117,"@type":113},"The ILM was dissected near the optic disc, a pedicled ILM flap was grasped, peeled from the superior edge, then directly rotated in a positive manner to cover the IMH.",{"name":119,"@type":110,"acceptedAnswer":120},"What outcomes were improved after treatment?",{"text":121,"@type":113},"IMH closure was achieved in all cases, and mean BCVA decreased significantly. SD-OCT showed reduced defects in the ellipsoid zone and external limiting membrane, with defect size further improving by later follow-ups.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},444261,1790956283,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},18829141979164,"https://eur-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Wiley  \nJournal of Ophthalmology  \nVolume 2026, Article ID 9081680, 8 pages [https://doi.org/10.1155/joph/9081680](https://doi.org/10.1155/joph/9081680)  \nResearch Article  \nPositive Rotational Internal Limiting Membrane Covering Technique for Large Idiopathic Macular Holes  \nHuiyu Xi , 1,2,3 Yingying Song ,4 Yewen Ni , 1,2 Yumei Cao , 1,2 Tianyu Zhu , 1,2 Wei Fan , 1,2,3 and Haiyang Liu 1,2,3  \n1 Te Afliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China  \n2 Department of Ophthalmology, Xuzhou First People’s Hospital, Xuzhou, China  \n3 Eye Disease Prevention and Treatment Institute of Xuzhou, Xuzhou, China  \n4 Department of Ophthalmology, Kaifeng Central Hospital, Kaifeng Eye Hospital, Kaifeng, China  \nCorrespondence should be addressed to Haiyang Liu; [liuhaiyang86@126.com](liuhaiyang86@126.com)  \nReceived 19 August 2025; Revised 25 November 2025; Accepted 4 December 2025  \nAcademic Editor: Kunbei Lai  \nCopyright © 2026 Huiyu Xi et al. Journal of Ophthalmology published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.  \nPurpose: Tis article aims to determine the efcacy of a modifed technique by a positive rotational internal limiting membrane (ILM) covering for the treatment of large idiopathic macular holes (IMHs) .  \nMethods: A prospective analysis was conducted on a cohort of 13 patients with large IMH (>400 μm) . Te ILM was dissected in approximately one diameter width of the optic disc from the inferior and temporal sides. Subsequently, a pedicled ILM fap connected to the optic disc was grasped and peeled from the superior edge of the residual ILM with a width of at least 2 papilla diameters (PDs). Te pedicled ILM fap was then directly rotated to cover the IMH in a positive way. Some peeled-ofILM samples were collected for scanning electron microscopy (SEM) examinations. During each follow-up, best-corrected visual acuity (BCVA), SD-OCT scans, and M-CHARTS were performed.  \nResults: Te study successfully detected IMH closure in all cases. Te mean BCVA (logMAR) showed a decrease from 1.18 ± 0.209 to 0.58 ± 0.202 (p \u003C 0.001) . Postoperatively, there was a signifcant reduction in the diameter of the ellipsoid zone (EZ) and external limiting membrane (ELM) defects compared to preoperative values (p \u003C 0.001) . Additionally, the defect size decreased further at the 3-month follow-up compared to the 1-month follow-up. Both horizontal and vertical deformations postoperatively showed signifcant improvements (p 􀂈 0.001, p \u003C 0.001) . At the fnal follow-up, 7 eyes exhibited U-shaped closure while 6 eyes showed V-shaped closure.  \nConclusion: Tis technique is an efective treatment for larger IMHs. Tis technique has the potential to improve vision outcomes.  \nTrial Registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR2300068411  \nKeywords: large idiopathic macular hole; positive internal limiting membrane fap; rotational covering technique  \n1. Introduction  \nPars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and gas tamponade was frst introduced as a treatment for MHs by Kelly and Wendel in 1991 [1]. It has been widely accepted as the standard surgery for idiopathic macular holes (IMHs) due to the high closure  \nrate, especially for those with a size less than 400 μm. However, for IMHs larger than 400 μm, the closure rate is lower. Te application of the ILM covering technique can improve the closure rate and lead to a better functional prognosis for large IMHs. Studies have demonstrated that the ILM fap can act as a scafold for the proliferation of glial cells along with remaining M¨uller cells [2] . Te inverted ILM  \n2 Journal of Ophthalmology  \nfap technique, frst reported by Michalewska, is one of the most widely studied surgical procedures [3] . However, it has been reported that the inverte","cbCaivffkhwdKgj5","https://ap.wps.com/l/cbCaivffkhwdKgj5","pdf",2606307,"English","# Introduction\n# Methods\n# Results\n# Conclusion","[{\"question\":\"What is the purpose of the positive rotational ILM covering technique?\",\"answer\":\"The study aims to determine the efficacy of a modified technique using positive rotational ILM covering for treating large idiopathic macular holes.\"},{\"question\":\"How was the ILM flap prepared and used during surgery?\",\"answer\":\"The ILM was dissected near the optic disc, a pedicled ILM flap was grasped, peeled from the superior edge, then directly rotated in a positive manner to cover the IMH.\"},{\"question\":\"What outcomes were improved after treatment?\",\"answer\":\"IMH closure was achieved in all cases, and mean BCVA decreased significantly. SD-OCT showed reduced defects in the ellipsoid zone and external limiting membrane, with defect size further improving by later follow-ups.\"}]","Positive Rotational Internal Limiting Membrane Covering Technique for Large Idiopathic Macular Holes | PDF",1790707355]