Purpose: To present a surgical technique that combines an inverted internal limiting membrane (ILM) flap and subretinal injection of balanced salt solution for the closure of chronic macular holes (MHs). Methods: Two cases were evaluated. Results: A 74-year-old man and a 63-year-old woman presented with decreased visual acuity (VA) of 20/600 and 20/200, respectively, resulting from a chronic MH. Both patients had vitrectomy, during which the ILM flap was inverted and a 38-gauge subretinal needle was used to inject balanced salt solution near the vascular arcade, creating a retinal bleb. Injection of the balanced salt solution into the MH with a backflush needle completed the detachment. The MH was then closed by a gas tamponade with improvements in VA in both patients to 20/50 and 20/40, respectively. Conclusions: The combined inverted ILM flap and subretinal injection of balanced salt solution into the MH, extending the detachment, led to the successful closure of a chronic MH.
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