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

The aim of the study was to evaluate the potency and security of pneumatic vitreolysis (PVL) as the primary treatment for full-thickness macular holes (FTMHs) and provide insights into patient selection criteria and procedural outcomes.

A retrospective analysis of three clinical cases presenting with FTMHs treated initially with PVL was conducted. Cases were evaluated for anatomical and functional outcomes through comprehensive ophthalmic examination and optical coherence tomography (OCT) imaging. Patient demographics, preoperative characteristics, procedural details, and postoperative outcomes were documented.

Pneumatic vitreolysis demonstrated favorable outcomes in two out of three cases, with complete closure of FTMHs and restoration of visual acuity. One case exhibited significant reduction in hole diameter but required subsequent pars plana vitrectomy for closure. No intraoperative complications were noted. Factors such as active vitreomacular traction (VMT), head down position, and smaller macular hole sizes appeared to positively correlate with successful closure following PVL. Thorough preprocedural assessment of retinal periphery and OCT evaluation of macular hole (MH) characteristics aided in patient selection and treatment planning.

Pneumatic vitreolysis emerges as a promising initial treatment option for select FTMH cases, particularly those with active VMT and smaller MH sizes. Its less invasive nature and favorable outcomes make it a valuable alternative to traditional surgical interventions. Patient selection based on preoperative characteristics, including VMT status and MH size, is crucial for optimizing treatment success. Further research and long-term studies are warranted to refine patient selection criteria, procedural techniques, and outcomes assessment in PVL for FTMHs.