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. 2021 Jun 17;6(1):14-21.
doi: 10.1177/24741264211018958. eCollection 2022 Jan-Feb.

Surgical Macular Hole Closure Without a Gas Tamponade

Scott Grant  1 , Sean D Adrean  1
Affiliations

Surgical Macular Hole Closure Without a Gas Tamponade

Scott Grant et al. J Vitreoretin Dis. .

Abstract

Purpose: This work aims to evaluate the outcomes of a series of macular hole (MH) surgical procedures in patients who had pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peel and without gas tamponade.

Methods: Patients from a retina specialty clinic who had MHs were identified for this interventional case series. Patients with small MHs were offered inclusion into the trial. Patients with larger MHs were excluded. They underwent standard 3-port PPV and ILM peel without gas or air to treat small MHs. The main outcomes that we measured were closure of MH and visual results.

Results: Small MHs in 5 patients were managed with PPV and ILM peel alone. The average preoperative hole size at its narrowest width was 227 µm (range, 173-294 µm). Four of 5 patients (80%) had successful hole closure without a gas tamponade and improved vision; 1 patient did not have hole closure and was treated with an in-office gas bubble to close the hole. The average preoperative vision at 3 months was 20/80- (54 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and improved to 20/30-2 (73 ETDRS letters) in the 4 patients whose MHs were closed with surgery without a gas bubble. This was statistically significant (P = .003). The hole that did not close initially without gas tamponade was the largest in the series.

Conclusions: Patients with small MHs can be successfully treated with a vitrectomy and ILM peel alone without a gas tamponade.

Keywords: intraocular; intraocular gases; macular holes; small-gauge vitrectomy; tamponades.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Patient 1. (A) Preoperative vision is 20/80. (B) Postoperative day 1, vision is 20/200 with closed macular hole. (C) Postoperative week 1, vision is 20/60. (D) Postoperative month 3, vision is 20/40.
Figure 2.
Figure 2.
Patient 2. (A) Preoperative vision is 20/70. (B) Postoperative day 1, vision is 20/80 with a smaller gap, but the macular hole is still open. (C) Postoperative day 4, vision is 20/60 with a decreasing gap between the edges of the macular hole. (D) Postoperative day 7, the hole is almost closed, with a very small gap. Vision is 20/50. (E) On postoperative day 10, the hole is closed, and vision is 20/50. (F) At postoperative month 3, the hole is closed, and vision is 20/30.
Figure 3.
Figure 3.
Patient 3. (A) Preoperative vision is 20/60. (B) Postoperative day 1, vision is 20/60 with closed hole. (C) Postoperative week 1, vision is 20/40. (D) Postoperative month 3, vision is 20/30.
Figure 4.
Figure 4.
Patient 4. (A) Preoperative vision is 20/70. (B) Postoperative day 1, vision is 20/200 with a closed hole. (C) Postoperative week 1, vision is 20/40. (D) Postoperative month 3, vision is 20/30.
Figure 5.
Figure 5.
Patient 5. (A) Preoperative vision is 20/100. (B) Postoperative day 1, vision is 20/400 with an open macular hole. (C) Postoperative day 3, vision is 20/200 with an open hole and slightly larger gap between the edges of the hole. (D) On postoperative day 4, the decision is made to inject 0.3 mL of 100% perfluoropropane (C3F8) with face-down positioning. On postoperative day 5, which is the first day after in-office gas placement, the hole is smaller, with vision at 20/200. (E) On postoperative day 8, the third day after in-office gas placement, the hole continues to get smaller, and vision is 20/200. (F) On postoperative day 14, the ninth day after in-office gas placement, the hole is closed, and vision is 20/100. (G) At postoperative month 3, vision is 20/50.
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