Does sulfur-hexafluoride tamponade, as an adjunct to vitrectomy and internal-limiting-membrane peeling, suffice for the treatment of retinal detachment associated with macular hole?

Abstract

Objective: To evaluate the efficacy of sulfur hexafluoride tamponade, as an adjunct to vitrectomy and internal-limiting-membrane peeling, for the treatment of retinal detachment (RD) associated with macular hole (MH).

Materials and methods: Our study was a retrospective interventional case series. We evaluated 9 phakic eyes of 9 consecutive patients with retinal detachment secondary to macular hole (MHRD) treated with 20-gauge (g) pars plana vitrectomy, which was followed with trypan blue–assisted internal-limiting-membrane peeling, fluid–air exchange, and 20% sulfur hexafluoride tamponade (SF₆) gas exchange. All patients underwent optical coherence tomography, best-corrected visual acuity (BCVA) measurement, and dilated fundus examination with indentation, pre- and postoperatively.

Results: The mean (± standard deviation) follow-up time was 13 ± 3 months (range 9–18). Postoperatively, all eyes demonstrated an attached retina, whereas MH closure was achieved in only 1 eye, and in a second eye after additional injection of gas and further posturing. The BCVA improved from 2.2 ± 0.4 logMAR (logarithm of the minimum angle of resolution) at baseline to 2.0 ± 0.5 logMAR at the end of follow-up (p = .05).

Conclusion: The failure in MH closure in most of our cases strengthens the view that short-term tamponade with SF₆ may not suffice for achieving MH closure, and either prolonged tamponade (with C₃F₈ or silicone oil) or additional photocoagulation may be a better option for eyes with MHRDs. In addition, it is possible that intravitreal injection of gas might be an option for the treatment of persistent MHs after vitrectomy for MHRD, especially when the MH is small. Further studies are required to evaluate the above findings, although the implementation of large series studies remains a challenge because of the rarity of cases with MHRDs.

Keywords::

• Myopia
• macular hole
• retinal detachment
• ILM peeling
• gas