Intravitreal gas injection for early persistent macular hole after primary pars plana vitrectomy

To report the clinical presentations and outcome of early intravitreal injection (IVI) of octafluoropropane (C₃F₈) for persistent macular holes (MH) after primary pars plana vitrectomy with the internal limiting membrane (ILM) peeling technique.

Nineteen eyes of 18 patients with persistent MH after vitrectomy underwent intravitreal injection of C₃F₈ between 11 and 21 days after the initial surgery (intravitreal gas injection group). Another nine eyes with a persistent MH without additional IVI C₃F₈ were included (non-intravitreal gas injection group). Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) features including size and configuration of MH, and time duration between the 2 surgeries were compared between the MH closure and open groups. The closure rate of persistent MHs was compared between the intravitreal gas injection group and non-intravitreal gas injection group.

Twelve of 19 eyes (63%) achieved MH closure after 1 to 3 times IVI C₃F₈. The final BCVA after vitrectomy and IVI gas was significantly better in the MH closure group (P = .005). Nine of 12 patients (75%) in the MH closure group had a visual acuity improvement of more than 2 lines. Original MHs with smaller minimal diameter, higher macular hole index (MHI) and higher tractional hole index (THI); and persistent MHs with smaller minimal diameter, higher THI, and lower diameter hole index (DHI) showed higher MH closure rate. None of the persistent MHs closed in the non-intravitreal gas injection group (0/9 eyes).

Early intravitreal injection of C₃F₈ can be a cost-effective first-line treatment for early persistent MHs after primary surgery, especially in eyes with favorable OCT features.