Additional intravitreal gas injection in the early postoperative period for an unclosed macular hole treated with internal limiting membrane peeling.

摘要

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 > or =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.