Materials and Methods: Ten eyes of 10 consecutive patients who underwent free ILM flap transplantation combined with pars plana vitrectomy surgery due to large or persistent MHs (diameter> 400 ?m), and who used silicone-oil as an endotamponade were reviewed retrospectively. All patients underwent detailed ophthalmological examination and optical coherence tomography measurements at the first, third, sixth, and twelfth months postoperatively. Silicone-oil was removed in all cases at the third months postoperatively. The rates of anatomical closure, bestcorrected visual acuity (BCVA) values, and ellipsoid zone disruption (EZD) values were compared within the preoperative and postoperative periods.

Results: The mean age of the patients was 69.20±4.94 years. Seven patients (70.0%) were female, and 3 patients (30.0%) were male. Anatomical closure was achieved in all eyes postoperatively. The mean BCVA values increased compared to baseline (0.95±0.27) at postoperative first month (0.93±0.34), and third months (0.87±0.32), but this increase was not statistically significant (p=0.809, p=0.237, respectively). The mean BCVA values significantly improved compared to baseline at postoperative sixth months (0.54±0.28), and twelfth months (0.47±0.21) (p=0.000, p=0.000, respectively). The mean EZD diameter significantly decreased compared to baseline at all follow-up visits. No complications were observed.

Conclusions: Free ILM flap transplantation and the use of silicone-oil as an endotamponade provide an increase in BCVA levels, high anatomic closure rates, and improvement in EZD. Keywords : Macular hole, Internal limiting membrane, Free flap, Silicone-oil, Ellipsoid zone