"CHOOSING WISELY": INTRAVITREAL GAS INJECTION AS FIRST-LINE TREATMENT FOR MACULAR HOLE-A CLINICAL CASE PERSPECTIVE

Area of Science:

• Ophthalmology
• Retinal Surgery
• Vitreoretinal Interface Disorders

Background:

• Full-Thickness Macular Holes (FTMHs) are a significant cause of visual impairment.
• Traditional surgical interventions like pars plana vitrectomy (PPV) carry risks and require specific patient profiles.
• Exploring less invasive treatment alternatives for FTMHs is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of Pneumatic Vitreolysis (PVL) as a primary treatment for FTMHs.
• To identify patient selection criteria that optimize success rates for PVL.
• To analyze procedural outcomes and complications associated with PVL in FTMH treatment.

Main Methods:

• Retrospective analysis of three clinical cases of FTMHs treated with PVL.
• Assessment of anatomical and functional outcomes using ophthalmic examination and optical coherence tomography (OCT).
• Documentation of patient demographics, pre-operative characteristics, procedural details, and post-operative results.

Main Results:

• PVL led to complete FTMH closure and visual acuity restoration in two of three cases.
• One case required subsequent PPV for successful closure despite initial PVL treatment.
• No intraoperative complications were observed; factors like active vitreomacular traction (VMT) and smaller macular hole (MH) size correlated with successful PVL outcomes.

Conclusions:

• PVL is a viable initial treatment option for select FTMH patients, especially those with active VMT and smaller MHs.
• PVL offers a less invasive alternative to traditional surgery, with favorable outcomes in appropriate candidates.
• Careful patient selection based on pre-operative OCT and VMT assessment is critical for maximizing PVL success rates in FTMH management.