Treatment of persistent flap closure with fluid gas exchange after inverted internal limiting membrane flap technique for idiopathic macular hole

Abstract

We evaluated the results of fluid-gas exchange (FGE) for long-term flap closure of idiopathic macular holes (MH) using the inverted internal limiting (ILM) flap technique. We retrospectively included eyes showing flap closure without complete MH closure and connection of separate macular tissue 1 month postoperatively after the inverted ILM flap technique was detected by ocular coherence tomography at follow-up. Eyes remained flap closure at 2 months after surgery further underwent in-office FGE with 16% C3F8. Of the 153 eyes using the inverted ILM flap technique for idiopathic MH between June 2015 and November 2018, 10 eyes (6.99%) remained flap closure at 1 month postoperatively. Among 10 eyes, 5 eyes (50%) showed flap closure at 2 months postoperatively further underwent FGE for complete MH closure, while the remaining 5 eyes (50%) progressed directly to normal macular structures at 2 months postoperatively. Improvement in vision of all flap closure from baseline was significant (P = .015), with a mean baseline vision of 1.19 [Snellen equivalent (SE), 20/307] ± 0.52 logMAR and the mean final vision of 0.63 (SE, 20/85) ± 0.38 logMAR. The group that underwent FGE showed better final vision of 0.45 (SE, 20/75) ± 0.23 logMAR than the group that did not undergo FGE (0.81 [SE, 20/128] ± 0.44 logMAR). All eyes achieved complete MH closure, including the eyes that underwent FGE in a mean period of 5.60 months (range 3–10 months) after the inverted ILM flap technique. Eyes that underwent FGE achieved a higher rate of foveal restoration [complete external limiting membrane 80%; complete ellipsoid zone (EZ) 60%] than those that did not receive FGE (complete external limiting membrane: 40%; complete EZ: 10%). Eyes with persistent flap closure for more than 2 months postoperatively that underwent FGE showed accelerated complete MH closure, better final vision, and foveal restoration.