CLOSING MACULAR HOLES WITH "MACULAR PLUG" WITHOUT GAS TAMPONADE AND POSTOPERATIVE POSTURING.

Area of Science:

• Ophthalmology
• Retinal Surgery
• Surgical Innovation

Background:

• Macular holes, particularly large Stage 3 and 4, present surgical challenges.
• Traditional macular hole surgery often requires gas tamponade and specific postoperative patient positioning.
• Alternative techniques are sought to improve outcomes and patient comfort.

Purpose of the Study:

• To evaluate the efficacy of a modified surgical approach for large macular holes.
• To assess outcomes without using gas tamponade or postoperative posturing.
• To investigate the use of autologous gluconated blood clumps as a macular plug.

Main Methods:

• A retrospective case series involving 26 patients with Stage 3 and 4 macular holes (mean base diameter >500 μm).
• Pars plana vitrectomy with internal limiting membrane (ILM) peeling and inverted ILM flap repositioning (ILMR).
• Autologous gluconated blood clumps were used as a macular plug; no fluid-air exchange, endotamponade, or posturing was employed.

Main Results:

• 100% macular hole closure was achieved in a single surgery.
• Median best-corrected visual acuity improved significantly from 6/60 (1.0 logMAR) to 6/18 (0.50 logMAR) (P < 0.001).
• No major intraoperative or postoperative complications were noted; three patients required subsequent cataract surgery.

Conclusions:

• The combined technique of ILM peeling, ILMR, and autologous blood plug is effective for large macular holes.
• This method offers satisfactory anatomical closure and significant functional visual improvement.
• It provides a viable surgical option avoiding gas tamponade and postoperative posturing.