Macular hole surgery in conjunction with endolaser photocoagulation

To determine whether endolaser photocoagulation to the retinal pigment epithelium at the base of a macular hole increases the anatomic success rate of surgery.

In a prospective consecutive clinical trial, eight eyes of seven patients with idiopathic macular hole underwent vitrectomy with posterior cortical vitreous removal and peeling of visible epiretinal membrane when present. A single shot of argon endolaser photocoagulation was applied to the retinal pigment epithelium at the center of the macular hole with a duration of 0.05 to 0.2 seconds and an intensity of 50 to 200 mW. After fluid-gas exchange was performed with 14% perfluoropropane gas, patients maintained face-down positioning for 2 weeks.

One eye with stage 2 macular hole, six eyes with stage 3 macular hole, and one eye with stage 4 macular hole were included. All eight eyes had a closed macular hole (100% anatomic success rate) at final examination 6 to 12 months after surgery. Best-corrected visual acuity improved 3 or more lines on the Early Treatment Diabetic Retinopathy Study visual acuity chart in all eyes. Four (50%) of the eight eyes had a final visual acuity of 20/40 or better.

Endolaser photocoagulation may be a useful adjunct to macular hole surgery but requires further investigation and long-term evaluation.