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

Sir,

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.

We had three patients who were elderly females (aged between 62 and 65 years) with a history of diminution of vision. On examination, there was nuclear sclerosis grade 2 with cortical cataract. Fundus examination revealed full thickness macular hole in left eye of one patient and right eye of two patients, which was confirmed on optical coherence tomography (OCT) [Fig 1]. Patients underwent phacoemulsification with intraocular lens implantation, vitrectomy, internal limiting membrane peeling and 14% c3f8 gas injection. Patients were advised to maintain prone position for 14 h for 1-week. At 6 weeks follow-up, there was no improvement in the visual acuity and the macular hole persisted though the OCT revealed a decrease in the size of macular hole with a cuff of subretinal fluid (SRF) [Fig 2]. The option of resurgery was discussed with the patients and informed consent was obtained. All three patients underwent fluid air exchange with 14% c3f8 gas injection. At the 6 weeks follow-up after the second surgery, there was improvement of three lines in visual acuity in two patients and two lines in the third patient. Fundus examination showed closed macular hole and OCT confirmed closure of macular hole [Fig 3].

Figure 1

Baseline optical coherence tomography scan showing full thickness macular hole

Figure 2

Six weeks following primary surgery showing non closure of macular hole and cuff of subretinal fluid

Figure 3

Six weeks following re-surgery showing type 1 closure of macular hole

The macular holes in all three of our patients had a persistent cuff of SRF.

Though the number of cases treated is small, repeat fluid air exchange and gas in cases of persistent macular hole is a viable option for closure of the macular holes.