Additional gas injection after failed macular hole surgery with internal limiting membrane peeling

PURPOSE: To report the efficacy of additional intravitreal gas injection in eyes where primary failure occurred following apparently successful macular hole surgery. METHODS: Patients presenting with macular hole underwent a primary surgical procedure consisting of vitrectomy with phacoemulsification and intraocular lens implantation. The internal limiting membrane was stained with indocyanine green and peeled. At the end of this manoeuvre a fluid-gas exchange was performed and the macular hole tamponaded with 20% sulphur hexafluoride. The patients were instructed to assume a face-down position for 12 h per day until the macular hole closed. In those cases where primary closure was not achieved, an additional quantity of 20% sulphur hexafluoride was injected into the vitreous cavity via a 27-gauge needle connected to a 5-mL syringe. The patients were instructed to assume the same position. RESULTS: A total of 40 eyes from 40 consecutive patients underwent primary macular hole surgery. The macular hole was not successfully closed in seven eyes and a further gas injection was made in these eyes. This additional procedure led to macular hole closure in all cases within a mean of 4.1 days. Visual acuity improved in all seven eyes, and the final visual outcomes were no worse than those eyes that had successful primary closure. CONCLUSIONS: Additional gas injection is an effective treatment for eyes with open holes following unsuccessful primary surgery.