Efficacy of sulfur hexafluoride (SF₆) versus perfluoropropane (C₃F₈) tamponade in large macular hole

To evaluate the efficacy of SF₆ versus C₃F₈ gas tamponade for large idiopathic macular holes.

The study included 60 eyes with large macular holes managed with pars plana vitrectomy, inverted internal limiting membrane flap, and gas tamponade with either SF₆ group (30 eyes of 30 patients) or C₃F₈ group (30 eyes of 30 patients). Based on minimal linear diameter (MLD), subjects were further classified into two groups: large (400 - <600 μm) or very large (>600 μm); compared for anatomical closure, improvement in best corrected visual acuity, and development of complications.

Both groups were comparable in baseline features of age, sex, etiology, and size of hole, with significantly larger MLD (708.2 ± 154.62 vs. 622.6 ± 114.08 μm; p=0.017) and a poorer macular hole index (0.36 ± 0.06 vs 0.31 ± 0.04; p=0.003) in the SF₆ group. Macular hole closure was achieved in all eyes in the C₃F₈ group and 29 of 30 eyes in the SF₆ group. Significant improvement was observed in vision in both groups from baseline at six months post-surgery. Cataract development/progression was observed in one patient in both groups, with no significant increase in intraocular pressure. In sub-groups of very large macular holes, despite significantly larger MLD and poorer macular hole index in the SF₆ group, structural and functional outcomes were comparable to C₃F₈.

The management of large macular holes is a critical challenge as these conditions can severely impair central vision and quality of life for affected patients. Surgical intervention using tamponade agents is a standard approach to promote hole closure and retinal healing. Both SF₆ and C₃F₈ have demonstrated effectiveness in promoting macular hole closure. While the evidence is somewhat mixed, several studies indicate that SF₆ may be associated with quicker visual recovery in the early postoperative period. However, the long-term visual outcomes are often comparable between the two agents. In the present study, we compared the efficacy of both these tamponade agents for large and very large idiopathic macular holes.

Both SF₆ and C₃F₈ tamponades are equally effective in the treatment of large macular holes. However, despite poorer pre-operative prognostic factors like larger MLD and macular hole index, the efficacy and safety of SF₆ gas tamponade are comparable to C₃F₈ tamponade.