In-Office Sulfur Hexafluoride (SF6) Injection to Close Recently Operated or Reopened Macular Holes: A Minimal Approach Technique.

Abstract

To describe an in-office minimal approach technique for closing recently operated full thickness macular holes (FTMH), when closure was not fully achieved or there was macular hole re-formation, without performing another pars plana vitrectomy (PPV). Retrospective case series study. Nine patients were included in this case series. All patients were diagnosed with FTMH characterized by a decrease in visual acuity (VA) and metamorphopsias. All patients initially underwent a standard PPV procedure with 20% sulfur hexafluoride (SF6) injection. After 1-16 weeks, no closure or reformation of the macular hole was observed. Fluid-SF6 exchange was performed in the slit lamp, with the aim of injecting a 50% gas bubble of pure SF6 into the vitreous cavity, according to a minimally invasive in-office technique. Postoperatively, all patients achieved successful macular hole closure and VA showed an average improvement of approximately 4 lines on the EDTRS logarithm of the minimum angle of resolution (logMAR) chart. In particular, the mean corrected distance visual acuity improved from 0.99 ± 0.27 logMAR to 0.33 ± 0.23 logMAR (P = 0.03). The minimal surgical in-office technique of SF6 injection for the management of reopened macular holes after a recent PPV procedure shows promising results.