Intraoperative Closure of Large Full-Thickness Macular Holes with Perfluorocarbon Liquid.

Abstract

To report the role of perfluorocarbon liquid (PFCL) and passive extrusion for the management of large full-thickness macular holes (FTMHs). A standard pars plana vitrectomy with induction of posterior vitreous detachment was performed for all patients. After internal limiting membrane peel, a bubble of perfluorocarbon liquid (PFCL) was injected over the posterior pole, and passive extrusion of fluid was performed with a backflush instrument below the PFCL bubble, without touching the FTMH edges, until the FTMH center was reached. Intraoperative optical coherence tomography showed the formation of an inner retina roof in all cases and confirmed intraoperative FTMH closure. Complete PFCL removal was performed after fluid-air exchange, and gas tamponade was used in all cases. Preoperative FTMH mean aperture size was 761 µ m, and SD 100 µ m (range 682-918 µ m). Full-thickness macular hole closure was achieved in all eyes and visualized intraoperatively with optical coherence tomography. After an average follow-up of 2 months, there was improvement in the mean best-corrected visual acuity and central scotoma. FTMH closure can be achieved intraoperatively with the use of PFCL and passive extrusion. The described surgical technique could be a valid alternative for the repair of large FTMHs.