Subretinal fluid application to close a refractory full thickness macular hole

Area of Science:

• Ophthalmology
• Retinal Surgery

Background:

• Full-thickness macular holes (FTMH) present a significant challenge in retinal surgery.
• Traditional methods may fail to close large or refractory FTMH, even after epiretinal membrane removal.

Observation:

• A case of an 83-year-old patient with a large (1444 μm) FTMH is presented.
• Subretinal fluid blebs were strategically placed to release the retina from the retinal pigment epithelium (RPE).
• The mobilized retina was repositioned, and silicone oil tamponade was used for healing.

Findings:

• The 1444 μm FTMH achieved anatomical closure, confirmed by OCT 5 days post-surgery.
• Retinal architecture was restored, and no late reopening was observed.
• Visual acuity improved from hand motion to 20/200 within 4 weeks.

Implications:

• Subretinal fluid application offers a novel approach for closing large FTMH by overcoming retinal rigidity.
• This technique may enhance anatomical and functional outcomes in challenging macular hole cases.
• It highlights the potential of fluid dynamics in retinal repositioning and hole closure.