Posterior Pole Detachment Technique for the Management of Full Thickness Macular Hole

Abstract

Purpose: To investigate the clinical characteristics, visual and anatomical outcomes of a series of large full thickness macular holes treated by vitrectomy, ILM peeling and gas tamponade augmented by retina expansion. Methods: Prospective, non-comparative, interventional case series of seven eyes of seven patients with Gass Stage 3 or above full thickness macular hole presenting to a vitreo-retinal unit of a tertiary eye hospital. All patients underwent 23 gauge pars plana vitrectomy, peeling of the internal limiting membrane, retina expansion through detachment of the posterior pole with injection of balanced salt via a 41-gauge subretinal cannula, and gas tamponade with sulfur hexafluoride gas. The main outcome measures were: anatomical closure of the macular hole and post-operative visual acuity. Results: Six cases were Gass Stage 3, and one Gass Stage 4. Preoperative visual acuity ranged from hand movement to 6/36. Patients were followed post operatively for a minimum of 6 months. Anatomical closure of the full-thickness macular hole was successfully achieved and confirmed on optical coherence tomography in six of the seven cases. All patients in our case-series recorded improved visual acuity by 6 months follow up. Six patients attained a postoperative best corrected Snellen visual acuity of 6/24 or better. Conclusion: The retina expansion technique has demonstrated promising results in improving anatomic and visual outcomes in patients with large, chronic, full thickness macular hole. The proposed mechanism is the undermining of the retina by fluid to facilitate approximation of the hole edge and aid migration of glial cells to close the foveal defect.