ADDITIONAL INTRAVITREAL GAS INJECTION IN THE EARLY POSTOPERATIVE PERIOD FOR AN UNCLOSED MACULAR HOLE TREATED WITH INTERNAL LIMITING MEMBRANE PEELING


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Abstract

Purpose:To study the efficacy of additional intravitreal gas injection for unclosed macular holes within 2 weeks after surgery with internal limiting membrane peeling.Methods:We reviewed the results for five consecutive eyes receiving additional intravitreal gas injection for unclosed macular holes within 2 weeks after initial macular hole surgery with internal limiting membrane peeling. The initial surgery consisted of standard pars plana vitrectomy with phacoemulsification and intraocular lens implantation, indocyanine green–assisted peeling of the retinal internal limiting membrane, and fluid–gas exchange with 20% sulfur hexafluoride. The patients were instructed to assume face down positioning for ≥7 days after surgery. If an unclosed macular hole was found after the residual gas volume decreased to <30% of the eyeball volume, fluid–gas exchange was performed using 15% octafluoropropane.Results:All five eyes receiving additional intravitreal gas 7 to 14 days after vitrectomy had complete macular hole closure with macular flattening, as shown by optical coherence tomography 1 month after the additional gas injection. Visual acuity improved (range, 20/100 to 20/30). A minimum of 9 months of follow-up revealed no reopening or serious complications.Conclusion:Additional gas injection during the early postoperative period is recommended for eyes with unclosed macular holes that have undergone vitrectomy with internal limiting membrane peeling.

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