A 70-year-old woman presented for visual loss in the left eye for 1 year. Her best-corrected visual acuity (BCVA) was 20/400. A fundus examination revealed a macular hole. Optical coherence tomography confirmed the diagnosis of a large macular hole (diameter, 740 μm) with vitreomacular detachment (Figure, A).

She underwent surgical repair with an inverted-flap technique.¹ After vitrectomy, which included a posterior vitreous detachment, the internal limiting membrane was peeled around the hole, foveal attachment was maintained, and the flap was inverted to cover the hole. A mixture of sulfur hexafluoride gas and air was injected. The patient was asked to maintain facedown positioning for 2 days. Four months postoperatively, her BCVA was 20/80 OS. Optical coherence tomographic imaging showed a closed macular hole in a V-type pattern^2,3 (Figure, B). A bridge of the inverted internal limiting membrane topped the fovea in the shape of a Valentine heart.