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Surgical Macular Hole Closure Without a Gas Tamponade
1Retina Consultants of Orange County, Fullerton, CA, USA.
Purpose:
This work aims to evaluate the outcomes of a series of macular hole (MH) surgical procedures in patients who had pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peel and without gas tamponade.
Methods:
Patients from a retina specialty clinic who had MHs were identified for this interventional case series. Patients with small MHs were offered inclusion into the trial. Patients with larger MHs were excluded. They underwent standard 3-port PPV and ILM peel without gas or air to treat small MHs. The main outcomes that we measured were closure of MH and visual results.
Results:
Small MHs in 5 patients were managed with PPV and ILM peel alone. The average preoperative hole size at its narrowest width was 227 µm (range, 173-294 µm). Four of 5 patients (80%) had successful hole closure without a gas tamponade and improved vision; 1 patient did not have hole closure and was treated with an in-office gas bubble to close the hole. The average preoperative vision at 3 months was 20/80- (54 Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and improved to 20/30-2 (73 ETDRS letters) in the 4 patients whose MHs were closed with surgery without a gas bubble. This was statistically significant (P = .003). The hole that did not close initially without gas tamponade was the largest in the series.
Conclusions:
Patients with small MHs can be successfully treated with a vitrectomy and ILM peel alone without a gas tamponade.
Insights
Pars plana vitrectomy with internal limiting membrane peel alone can successfully treat small macular holes. This approach, without gas tamponade, offers improved vision for many patients with macular holes.
Area of Science:
- Ophthalmology
- Retina Surgery
Background:
- Macular holes (MHs) are a common cause of visual impairment.
- Standard surgical repair often involves pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peel and gas tamponade.
Purpose of the Study:
- To evaluate the efficacy of PPV with ILM peel alone, without gas tamponade, for the surgical treatment of small macular holes.
Main Methods:
- An interventional case series included patients with small MHs.
- Participants underwent standard 3-port PPV and ILM peel without gas or air.
- Primary outcomes measured were MH closure and visual acuity.
Main Results:
- Four out of five (80%) small MHs closed successfully with PPV and ILM peel alone.
- Patients with successful closure showed significant visual improvement (20/80- to 20/30-2).
- The single case of failed closure involved the largest MH in the series.
Conclusions:
- PPV with ILM peel alone is a viable and effective surgical option for small macular holes.
- This technique can achieve successful MH closure and visual recovery without the need for gas tamponade.
