A new surgical approach for repairing full-thickness macular holes eliminates the need for gas tamponade and postoperative positioning, directly addressing the most common drawbacks of the standard technique.
The traditional method, first introduced in 1991 and later refined in 1997 with internal limiting membrane (ILM) peeling, depends on injecting gas and keeping the patient face-down for several days. This protocol can achieve closure rates of up to 100% for large defects, yet it often delays visual recovery, creates a risk of raised eye pressure, and interferes with everyday activities.
Recent investigations have shown that many macular holes seal within the first 24 hours after surgery, prompting questions about the necessity of prolonged face-down positioning. Researchers have experimented with reduced gas volumes and alternative postures such as a relaxed reading position, although these variations remain relatively rare in clinical practice.
Read Also: New device treats Meibomian gland dysfunction
Surgeons typically persist with the established regimen because of lingering concerns over primary failure, even though emerging data suggest that closure may occur earlier than previously assumed.
In 2023, a team of investigators presented a technique that completely omits gas tamponade and eliminates the requirement for postoperative positioning. More recently, Szeto et al. reported a case series of 24 eyes with complex macular holes with a 100% closure rate. The same group has also published a comparative study demonstrating anatomical success rates comparable to those achieved with conventional surgery.
Kelly and Wendel reported the first successful full-thickness macular-hole repair in 1991, using pars plana vitrectomy, gas tamponade and a week of face-down positioning. In 1997, Eckardt et al. introduced internal limiting membrane peeling, which lifted closure rates from 58% to 92%. More recently, adding a temporal ILM flap has pushed anatomical closure to as high as 100% in large holes.
