**16. Autologous ILM free flap**

Eyes with an extensive ILM peel may benefit from a free ILM flap. Keeping the ILM in place during air-fluid exchange is never easy, but a small amount of heavy liquid or viscoelastic like Viscoat, can stabilise the flap [92, 93]. Patients who have a persistent MH hole following earlier surgery with ILM peeling may benefit from the use of an ILM-free flap [94]. Peripheral peeled ILM is placed on the MH during redo surgery. Successful results may be obtained in the closure of large MHs with this technique, but this procedure may cause damage to the retinal pigment epithelium in the fovea and alterations of the photoreceptor layers [95]. Prolonged exposure of the RPE to the staining fluids and stained ILM may also cause chemical damage to the RPE, as detected by De Novelli [96].
