Treatment of idiopathic macular holes by induced posterior vitreous detachment.

PURPOSE: To determine if an expansile gas bubble can relieve vitreofoveal traction without vitrectomy by inducing a posterior vitreous detachment (PVD) in eyes with an idiopathic impending or full-thickness macular hole (stages 1-3). The status of the impending and full-thickness macular holes after gas injection and tamponade also was studied secondarily.

METHODS

Eighteen patients participated in this pilot study. Eleven patients with an impending macular hole (stages 1A and 1B) and seven patients (8 eyes) with a full-thickness macular hole (stages 2 and 3) received gas injections and prospectively were followed for an average of 15.6 months (range, 3-42 months).

RESULTS

A complete PVD was achieved in 18 of 19 eyes without a prior PVD within 2 to 9 weeks after gas injection. Ten of the 11 impending holes (all 7 had stage 1A holes; 3 of 4 had stage 1B holes) resolved after gas injection. After gas tamponade, three of six early full-thickness (stage 2) macular holes closed. None of the stage 3 macular holes closed after gas injection. The mean best-corrected visual acuity of the successful eyes was 20/32. There were no major complications.

CONCLUSION

An expansile gas bubble consistently can induce a PVD in aging eyes. The ability of an expansile gas bubble to induce a PVD with minimal morbidity and expense may have clinical applications for macular hole therapy. Impending macular holes may resolve and some early full-thickness (stage 2) macular holes may close after gas injection and tamponade without vitrectomy. The efficacy and safety of this procedure may be evaluated further in the context of a carefully designed prospective and randomized study for selected patients with an idiopathic impending or early macular hole.