Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery

Abstract

A 65-year-old lady presented with decreased vision in left eye since seven months. Vision was 6/9 in right eye and 6/36 in left. Examination revealed idiopathic, full-thickness macular hole in left eye; confirmed by optical coherence tomography (OCT). Patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, internal limiting membrane (ILM) peeling and 14% C3F8 gas injection. OCT repeated after six weeks revealed type II closure with cuff of subretinal fluid. Four weeks later, patient underwent fluid–gas exchange with 14% C3F8 gas and postoperative positioning. OCT was repeated after two weeks, which showed complete closure of the macular hole. OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure. Macular holes with cuff of subretinal fluid are probably more likely to close on re-surgery than those without. However, larger studies with longer follow-up are required to validate this finding.

Current Practice Pattern for Macular Hole Management

“…A repeat surgery may comprise of fl uid air exchange and a gas tamponade or further extension of the ILM peel if it was not done adequately in the primary surgery. 26,27 A new technique of ILM patch graft has been described for persistent macular holes.…”

Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery-our experience

“…We read with great interest the article titled “Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery” by Dr. Rishi et al . [ 1 ] In this article, the authors have reported a case of macular hole which successfully closed with gas insufflation after the failure of the primary pars plana vitrectomy surgery for the closure of the macular hole. We would like to share our similar experience in three similar cases.…”

Repeat fluid- gas exchange for failed primary macular hole surgery

“…We read with interest the article “Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery” by Rishi et al . [ 1 ] We describe two cases with failed primary macular hole (MH) surgery that closed following repeat fluid-gas exchange (FGE) and make some additional observations.…”

“…Nonclosure or reopening of MH after a primary MH surgery can be managed by repeat ILM peeling,[ 2 ] additional FGE done externally (as an outpatient procedure)[ 3 ] or internally (repeat surgery). [ 1 ] Once the gas bubble has absorbed enough to allow adequate examination of the macula, an open MH with elevated edges and a cuff of SRF is unlikely to close or flatten without additional intervention. [ 3 ] The authors describe the MH following primary surgery as “type 2 closure of MH with cuff of SRF” [ Fig.…”

“…2 ] and mention that the cuff of SRF was a factor favoring re-surgery in their case. [ 1 ] Type 2 closure is used to denote attachment of the entire rim of the MH to the retinal pigment epithelium (RPE) with flattening of the cuff of SRF, and persistence of a foveal defect of the neurosensory retina, while type 1 closure indicates that the foveal defect is closed. [ 4 ] Thus, the appearance of their case following primary surgery is incorrectly labeled as type 2 closure.…”