Idiopathic Macular Hole Surgery without Intraocular Gas Tamponade: Surgical Technique, Biological Rationale, and Initial Clinical Experience

Overview

Aim: The aim of the study is to describe the technique of idiopathic macular hole (IMH) surgery without the use of intraocular gas tamponade and to present the author’s first clinical experience. Material and Methods: The operation is performed using pars plana vitrectomy, with the creation of an inverted internal limiting membrane flap (ILM flap). The flap of the patch is temporarily stabilized with decalin and then with an ocular viscoelastic device, without the subsequent use of gas tamponade (and without face-down positioning). The anatomical and functional outcome was evaluated with the aid of optical coherence tomography (OCT) and best-corrected visual acuity. Two case reports of patients with successful IMH closure using this technique are presented. Results: In all presented cases, anatomical closure of the macular hole was achieved and visual acuity improved. OCT demonstrated a relatively rapid restoration of the foveal architecture. The postoperative course was without complications and the patients were not burdened by the limitations and risks associated with gas tamponade. Conclusion: IMH surgery without gas tamponade represents a promising alternative to standard surgery. With the correct ILM flap technique, it enables us to achieve comparable anatomical and functional results while reducing the burden on the patient. However, further prospective studies are necessary to confirm the effectiveness of this method.

Keywords:

Pars plana vitrectomy – idiopathic macular hole – peeling – ILM flap – gasless surgery