Inverted internal limiting membrane flap technique and an autologous platelet concentrate to treat an Nd:YAG laser-induced macular hole: A case report

RATIONALE: Nd:YAG laser-induced macular holes (MHs) feature more extensive anatomical defects and worse functional outcomes than idiopathic MHs. Although new treatment options for large refractory MHs have been suggested, the current literature on Nd:YAG laser-induced MHs suggests only conventional pars plana vitrectomy combined with internal limiting membrane (ILM) peeling, which is the same treatment as for idiopathic MHs. PATIENT CONCERNS: A 40-year-old dermatologist was referred to us because of a sudden decrease in visual acuity following exposure to a floor-tile-reflected single-shot Nd:YAG laser beam while not wearing protective goggles. DIAGNOSES: An Nd:YAG laser-induced MH was diagnosed based on fundoscopy and optical coherence tomography (OCT). INTERVENTIONS: Pars plana vitrectomy using an inverted ILM flap technique and autologous platelet concentrate (APC) was performed. OUTCOMES: Postoperative spectral domain OCT and en-face OCT showed “U-shaped” closure of the MH and a decreased ellipsoid zone defect, while the best-corrected visual acuity improved from 20/500 to 20/25. LESSONS: The inverted ILM flap technique combined with APC is an effective option to achieve successful MH closure and visual improvement in patients with an Nd:YAG laser-induced MH.