Viscostretch: A Novel Surgical Technique for Refractory Macular Holes

We present a novel technique of subretinal viscodissection for addressing refractory macular holes (MHs).

A case report and surgical technique description are provided.

In this technique, standard pars plana vitrectomy with internal limiting membrane peeling (unless previously peeled) is performed. A cohesive ophthalmic viscosurgical device (OVD) is injected through the MH, focally detaching the parafoveal retinal tissue around the hole. The OVD is removed at the conclusion of the air-fluid exchange. We provide an example of a recurrent 833-µm MH that was successfully closed despite failing initial surgery. There was no retention of subretinal OVD, and anatomic closure was achieved in this patient with a refractory MH.

In refractory holes with adhesions at the MH base, this technique mobilizes the adjacent retinal tissue and uses the air's surface tension to facilitate closure. Surgeons can consider using this technique as part of their MH arsenal.