While the inverted internal limiting membrane (ILM) flap technique and autologous ILM transplant have been reported as novel surgical approaches for treating refractory macular holes (MH), the mechanisms underlying their efficacy are unknown. Thus, this study used MH models in animals and cultured Müller cells to investigate the role of inverted ILM flaps for MH closure. The proliferation of glial cells and their migration along the inverted ILM was observed after using the inverted ILM flap technique for MH closure in monkey eyes. This suggested that ILM may function as a scaffold for the proliferation and migration of glial cells. Further investigation using cultured Müller cells showed that ILM components promoted the growth and migration of these cells and that the production of neurotrophic and growth factors was enhanced by the activation of these cells. Moreover, neurotrophic and growth factors were observed in the specimens of human ILM, suggesting that inversed ILM flap may be a source of neurotrophic and growth factors to MH. These findings suggest that inverted ILM promotes Müller cell-mediated MH closure.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 123: 1020-1028, 2019.