Retrospective analysis of 19 eyes of 18 patients with large idiopathic macular hole (MH) was done. All patients underwent pars plana vitrectomy with multi inverted internal limiting membrane (ILM) flap + ILM peeling by single surgeon. Mandatory post-operative prone positioning was given for post op day-1. Follow up optical coherence tomography (OCT) on post op day 1, 3, 7, 14 and 30 were documented. All cases reported hole closure on day 1. On day-7 failure of surgery was noted for 2 eyes, glial plug captured on fundus imaging in case 1. Reconstructive morphological changes during closure of hole were documented in post-op silicon oil filled eye which showed active glial proliferative process on day-3. Our video discusses the various reconstructive and morphological changes underway in hole closure and correlates it with signs seen on OCT. It also discusses the role of discontinuation of positioning in failure of previously documented closed hole and optimal duration for the same.
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