A Modified Foveal Advancement Technique in the Treatment of Persistent Large Macular Holes

Abstract

BACKGROUND AND OBJECTIVE: To evaluate the outcomes of a new surgical technique on the closure of persistent large macular holes (MHs) PATIENTS AND METHODS: Data for 10 eyes of 10 patients who underwent surgical intervention for the treatment of large and persistent MHs were reviewed retrospectively. After entrance of the three-port transconjunctival 23-gauge sutureless vitrectomy instruments, a shallow perihole retinal detachment was formed by injecting a small amount of fluid with a 39-gauge /41-gauge subretinal cannula under the perihole (superior, temporal, and inferior sparing nasal bundle fibers) retina. Edges of the hole were brought closer with small, passive aspirations by a silicone-tipped cannula. After fluid-air exchange, a 39- gauge /41-gauge cannula was placed over the hole to remove submacular fluid. Then air was changed with 20% sulfur hexafluoride endotamponade. RESULTS: Mean minimum hole diameter was 691 mu m +/- 98 mu m (range: 500 mu m to 812 mu m), and mean basal diameter was 1,604 mu m +/- 321 mu m (range: 1,066 mu m to 2,200 mu m). Preoperative best spectacle-corrected visual acuities (BSCVAs) were lower than 20/200 in eight patients and were 20/200 in two patients. MHs were successfully closed in all eyes (100%). BSCVA did not change in two patients and were lower than 20/200. BSCVAs were 20/200 in six patients and greater than 20/200 in two patients. The ellipsoid zone (EZ) was lost in all patients. CONCLUSIONS: All the large and persistent MHs were successfully closed and stayed closed during follow-up period. However, increase in visual acuities was limited, which was related to the loss of the EZ. The authors' modified technique seems to be a good option for the surgical treatment of large and persistent MHs.