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A Refined Approach for Closing Refractory Macular Holes Using Subretinal BSS Injection.

Flavio Mac Cord Medina1, Guilherme Thome De Carvalho, Bruno Vasconcelos Coimbra

  • 1Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

Retinal Cases & Brief Reports
|December 30, 2025
PubMed
Summary

Subretinal injection of Balanced Salt Solution (BSS) effectively closed refractory macular holes in a case study. This technique offers a promising surgical option for complex retinal conditions.

Keywords:
Balanced Salt Solution (BSS)Hydraulic centripetal displacement Refractory macular holeSubretinal injection

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Area of Science:

  • Ophthalmology
  • Retinal Surgery

Background:

  • Macular holes are breaks in the macula, potentially causing vision loss.
  • Refractory macular holes present a surgical challenge, often requiring advanced techniques.

Purpose of the Study:

  • To describe a refined surgical technique for refractory macular holes.
  • To evaluate the efficacy of subretinal Balanced Salt Solution (BSS) injection for macular hole closure.

Main Methods:

  • Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade.
  • Subretinal injection of Balanced Salt Solution (BSS) was performed in a patient with a refractory macular hole.
  • Optical coherence tomography (OCT) and best-corrected visual acuity (BCVA) were used for assessment.

Main Results:

  • Successful closure of the refractory macular hole was confirmed by OCT one month postoperatively.
  • Best-corrected visual acuity (BCVA) improved to 20/100.
  • Macular hole remained closed at six months with partial restoration of retinal layers.

Conclusions:

  • Subretinal BSS injection is an effective method for closing refractory macular holes.
  • This technique represents a promising approach for complex macular hole cases.
  • Further studies are warranted to confirm efficacy in a larger cohort.