• Keran Li, Yunfan Zhou, Weihua Yang, Qin Jiang, and Xiangzhong Xu.
• Department of Fundus Disease, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
• Medicine (Baltimore). 2022 Jan 7; 101 (1): e28412.

RationaleInternal limiting membrane (ILM) peeling and gas tamponade are the standardized treatments for macular holes (MHs). However, the close rate is low, and postoperative vision is unsatisfactory in large, chronic MHs. Currently, various modifications of the ILM flap techniques are being gradually applied for large MHs in the hope of obtaining better postoperative effects. This study described 2 successful cases achieved by "Sandwich-type" modified ILM flap covering technique in patients with large, chronic MHs.Patient ConcernsA 62-year-old woman presented with decreased vision and visual distortion of the left eye for 18 months. Optical coherence tomography (OCT) showed the absence of full-thickness neuroepithelial tissue in the central fovea, with a minimum MH diameter of 742 μm and a base diameter of 1630 μm. A 57-year-old man experienced decreased visual acuity for 8 months. OCT showed the absence of full-thickness neuroepithelial tissue in the central fovea, with a minimum MH diameter of 713 μm and a basal diameter of 939 μm.DiagnosesTwo patients were diagnosed with large, chronic MH based on the OCT results and duration of the hole.InterventionsThe 2 patients were treated with the "sandwich-type" modified ILM flap covering technique.OutcomesLarge, chronic MH closure was observed using SD-OCT, and the BCVA improved. The patients were very satisfied with the postoperative results.Lessons"Sandwich-type" modified ILM flap covering technique may be a safe, effective way for large, chronic MH.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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