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 1 A and 1 B) and seven patients (8 eyes) with a fullthickness 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 1 A holes; 3 of 4 had stage 1 B 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.