Non-Surgical Pneumatic Repair of Stage 2 Macular Holes

Purpose: We report anatomical and functional outcomes of gas injection for small-medium full thickness macular holes (FTMH) with vitreomacular traction (VMT). Methods: This retrospective-comparative case series included patients with stage 2 FTMH who underwent intravitreal injection of perfluoropropane (C3F8) or sulfur hexafluoride (SF6) gas. Clinical evaluation included B-scan ultrasonography and spectral-domain optical coherence tomography (OCT) to assess post-procedure MH closure, vitreous status, and visual outcomes. Results: There were five men and seven women with a mean age of 63.75 years (range: 54-76). The median duration of symptoms was 8.5 months (range: 2-52 months). The mean BCVA at presentation was 0.51 LogMAR (Snellen equivalent 20/65). The mean macular hole aperture size was 206 (range: 127-334). In eight (67%) patients, FTMH closed after gas injection. All the four open holes underwent vitrectomy. The median follow-up was 11 months (range: 2-53 months). At the last follow-up, all the patients had type 1 MH closure; BCVA improved in 10 (83%). The mean post-treatment BCVA was 0.28 LogMAR (Snellen equivalent 20/38). One patient developed retinal tears, which were successfully treated with barrage laser photocoagulation. Conclusion: Intravitreal gas injection is a valid treatment modality for non-surgical macular hole closure, especially in smallmedium FTMH. Gas-assisted PVD induction and release of VMT provides a viable option for patients unwilling/unfit for vitrectomy, with no carry-over disadvantage in subsequent surgery in case of macular hole non-closure.