Study (year)

Country

Design

Intervention vs. comparator

MH type and baseline size

Sample size (per arm)

Anatomical closure

Follow-up

Abou Shousha 2024

Egypt

Single-centre RCT

“Flip and Fix” flap vs PFCL-assisted temporal flap

Idiopathic FTMH; mean min. diameter 561 vs. 597 µm

11 vs 11 eyes (22 eyes / 22 patients)

100% (11/11) vs. 90.9% (10/11)

6 months

Agrawal 2022

India

Single-centre RCT

Multilayered inverted ILM flap (under PFCL) vs. standard ILM peeling

Large idiopathic FTMH (base diameter >600 µm); mean min. diameter 766 (flap) / 750 (peel) µm

150 eyes (75 / 75)patients

Flap 100% (75/75) vs. peel 93.3% (70/75);

Type 1 closure 93.3%

Vs. 78.7% (P = 0.0001)

12 months

Babu 2020

India

Single-centre pilot RCT

Platelet-rich plasma (PRP) vs. inverted ILM flap

Idiopathic large FTMH 600-1500 µm, pseudophakic; mean min. diameter 785 (PRP) / 803 (flap) µm

60 patients (30 / 30); 1 eye each

PRP 93.3% (28/30) vs. flap 90% (27/30) (P = 0.158); Type 1 closure 83.3% vs 76.7%

3 months

Baskaran 2023

India

Single-centre, double-blind RCT

PFO-assisted inverted ILM flap vs. conventional ILM peeling

Large idiopathic FTMH (aperture >500 µm); mean min. diameter 721 (flap) / 677 (peel) µm

99 eyes (54 flap / 45 peel); 97 analysed

Flap 100% (27/27) vs. peel 90% (18/20) at 12 mo (P = 0.176); flap significantly higher at 1 mo (89.8% vs. 62.5%) and 6 mo (100% vs 80.8%)

12 months

Casini 2017

Italy

Single-centre, single-masked RCT

Classic inverted flap vs inverted flap without extra manipulation; large MH >400 µm

Idiopathic FTMH, stage IV, large (>400 µm); mean min. diameter 561 vs 603 µm

41 vs 40 eyes (81 eyes / 78 patients)

97.6% (40/41) vs. 97.5% (39/40)

12 months

Ehrhardt 2023

France

Single-centre, open-label RCT

Temporal inverted ILM flap vs. conventional (complete) ILM peeling

Idiopathic MH >250 µm; median min. diameter 405 (flap) / 375 (peel) µm

65 patients; 60 analysed (30 / 30)

93.3% (28/30) in both groups (P = 1.00); 100% in both after second surgery

3 months (subset to 15-18 months)

Elwan 2022

Egypt

Single-centre RCT

Small (1–2 DD) vs large (2–4 DD) inverted ILM flap

Large idiopathic MH >400 µm; mean min. diameter ~590 µm

25 eyes (13 small / 12 large)

Small flap 84.6% (11/13) vs. large flap 91.6% (11/12) at 6 mo (P = 1.00)

6 months

Ferrara 2023

UK

Masked proof-of-concept RCT

Etched-tip vs. smooth-tip ILM forceps

Idiopathic FTMH, any size; mean min. diameter 450 vs. 473 µm

65 eyes operated; 33 vs. 32 per arm

95.4% overall (62/65); not reported per arm

6 months

Iovino 2018

Italy

Two-centre RCT

Subretinal fluid aspiration vs. inverted ILM flap

Stage IV FTMH >400 µm, pseudophakic; mean min. diameter ~665 µm

40 eyes (20 / 20)

100% (20/20) in both groups after first surgery

6 months

Jujo 2024

Japan

Multicentre (3 sites) RCT

Hemi-temporal vs. 360° ILM peeling

Idiopathic MH <400 µm, <6 mo duration; mean min. diameter 256 (hemi) / 239 (360°) µm

50 eyes; 46 analysed (23 / 23)

Hemi-temporal 73.9% (17/23) vs. 360° 100% (23/23) (P = 0.009); 100% in both after second surgery

6 months

Kannan 2018

India

Single-centre RCT

ILM peel vs inverted ILM flap; large MH 600–1500 µm

Idiopathic FTMH, large (600–1500 µm); mean min. diameter 760 vs 803 µm

30 vs. 30 eyes

76.7% (23/30) vs. 90% (27/30), P = 0.166; Type 1 70% vs 90%

6 months

Kannan 2021

India

Single-centre, single-blind RCT

ILM peel + hBBG staining vs. no staining

Idiopathic FTMH, stage ≥ 2 (<800 µm); mean size 563 vs. 548 µm

24 vs. 20 eyes (44 eyes / 42 patients)

100% vs. 100%

6 months

Kaya 2023

Turkey

Single-centre RCT

C3F8 (14%) vs. SF6 (20%) tamponade

Idiopathic FTMH, stage 34 (>400 µm); mean min. diameter 498 vs. 479 µm

20 vs 18 eyes (38 eyes / 38 patients; 42 randomized)

Closed-MH cohort by design

3 months

Lee 2024

Australia

Single-centre, double-blind, placebo-controlled RCT

Topical dorzolamide 2% vs. placebo (saline)

Idiopathic small FTMH <400 µm; mean diameter ~205 µm

32 patients (16 / 16)

18.8% (3/16) in both groups at 8 wk (P = 1.00); all persistent holes closed after rescue vitrectomy

8 weeks (then surgery if persistent)

Lindtjørn 2022

Norway

Multicentre (5 sites) noninferiority RCT

Air vs. SF6 gas tamponade (after PPV + ILM peel)

Primary MH ≤ 400 µm (small ≤ 250 / medium >250-400); median size 294 / 300 µm

150 patients (75 / 75)

Air 86.7% (65/75) vs. SF6 100% (75/75), ITT (P = 0.001); 100% in both after second surgery

Closure 2–8 weeks; last follow-up ~23–33 days

Mao 2025

China

Single-centre pilot RCT

iOCT partial peel + inferior flap vs. standard peel; Gass stage 4

Idiopathic MH, Gass stage 4; mean diameter 458 vs. 471 µm

18 vs. 16 eyes (34 eyes / 34 patients)

94.4% (17/18) vs. 87.5% (14/16), P = 0.26^c

6 months

Morescalchi 2019

Italy

Single-centre RCT

Complete vs. fovea-sparing ILM peel; MH >250 µm

Primary FTMH, medium/large (>250 µm); mean diameter 640 vs 610 µm

22 vs. 22 eyes (46 eyes / 45 patients)

96% (22/23) vs. 100%

12 months

Rishi 2022

India

Single-centre, 3-arm RCT

C3F8 vs. C2F6 vs. SF6 tamponade; stage III/IV

Idiopathic MH, stage III-IV; stratified <800 / >800 µm apical; overall mean min. diameter 549 µm

72 vs. 50 vs. 37 eyes (159 eyes)

Type 1: C3F8 74% / C2F6 80% / SF6 70%, P = 0.556^d

2 months

Sinawat 2021

Thailand

Single-centre RCT

1-DD vs. 2-DD (extended) conventional ILM peeling

Large idiopathic FTMH (MLD >400 µm); mean MLD ~633 µm

104 eyes; 100 analysed (49 1-DD / 51 2-DD)

1-DD 51.0% (25/49) vs. 2-DD 76.5% (39/51) (P = 0.008)

6 months

Tian 2023

China

Single-centre, double-blind pilot RCT

Peeled ILM reposition vs. ILM peeling

Idiopathic MH ≤ 600 µm; mean diameter 371 / 366 µm

30 patients; 27 analysed (13 reposition / 14 peel)^e

Reposition 86.7% (13/15) vs. peel 93.3% (14/15) (P= 0.60); 100% in both after second surgery^e

6 months

Ventre 2022

Italy

Single-centre RCT

Conventional ILM peeling vs inverted flap

Small-to-medium idiopathic FTMH ≤ 400 µm; mean diameter 254 (peel) / 269 (flap) µm

50 eyes (25 / 25)

100% (25/25) in both groups

12 months

Viana 2020

Brazil

Single-centre, examiner-masked RCT

Combined PPV/phaco vs. PPV/deferred phaco

Idiopathic FTMH, stage ≥ II; mean min. diameter 469 vs. 473 µm

33 vs. 32 patients (34 vs. 34 randomized); one study eye each^f

73% vs. 75%, P = 0.834

12 months

Yao 2019

China

Single-centre, noninferiority RCT

2DD vs. 4DD extent of ILM peel; idiopathic FTMH

Idiopathic FTMH (≤ 3 yr duration); mean min. diameter 476 vs. 493 µm

63 vs. 58 eyes (121 eyes / 121 patients)

82.5% (52/63) vs. 91.4% (53/58), P = 0.185^g

12 months (54 weeks)