SURGICAL CLOSURE OF MACULAR HOLE USING AN ABSORBABLE MACULAR PLUG

Background: The surgical management of macular holes has been a subjec t of controversy in recent years. Various techniques such as vitrectom y, membrane peeling, and gas tamponade with or without transforming gr owth factor-beta 2, and recently the use of autologous platelets have produced closure rates from 58% to 96%, depending on the stage of the hole. Methods: The authors present preliminary results in a study of 1 9 consecutive patients with stage 3 or stage 4 macular hole who underw ent vitrectomy followed by placement of an absorbable partially cross- linked gelatin plug in the macular hole. The vitreous cavity was fille d with a nonexpanding gas or air alone; the patient was instructed to maintain prone positioning for 2-3 days. Results: Anatomic attachment of the edges of the macular hole was achieved in 19 out of 19 patients with a minimum follow-up period of 6 months (average 11.5 months). Co nclusions: A cross-linked gelatin plug can effectively reattach the ed ges of macular holes of stages 3 and 4. Its use is recommended only in macular holes in high myopes with posterior staphyloma or recurrent m acular hole.