Outcomes of Outpatient Fluid-Gas Exchange for Open Macular Hole After Vitrectomy

Abstract

PURPOSE: To report the efficacy and safety of outpatient fluid-gas exchange for open macular hole after primary vitrectomy. DESIGN: Retrospective interventional case series. METHODS: SETTING: Institutional. PATIENTS: Thirty-six patients with primary failed closure or reopened holes after primary vitrectomy. INTERVENTION: Fluid-gas excahnge with 15% perfluoropropane (C3F8) or 20% sulfur hexafluoride (SF6) was performed to reclose the hole under topical anesthesia. MAIN OUTCOME MEASURES: The hole closure rate and type, pre- and postexchange best-corrected visual acuity (BCVA), and complication rates were assessed. RESULTS: Thirty-two eyes (89%) achieved anatomic success from 1-3 weeks after the fluid-gas exchange. Twenty-two eyes (61%) achieved type 1 closure, 10 eyes (28%) achieved type 2 closure, and 4 eyes (11%) did not achieve closure. The BCVA for type 1 closure improved significantly from logarithm of the minimal angle of resolution (logMAR) 1.66 ± 0.41 to 0.84 ± 0.41, with a P value <.001. The BCVA for type 2 closure improved from logMAR 1.77 ± 0.41 to 1.52 ± 0.41, with a P value of .05. All patients with an unclosed hole after fluid-gas exchange had a stage IV macular hole before the primary vitrectomy and a hole size larger than 1000 mm. The complication related to fluid-gas exchange procedure was transient high intraocular pressure, which responded well to topical antiglaucoma medications. There were 2 retinal detachment cases following the exchange; surgery to reattach the retina was performed, with visual acuity recovery. CONCLUSION: Outpatient fluid-gas exchange is an effective treatment option for eyes with open holes following vitrectomy.