OUTPATIENT POSTOPERATIVE FLUID-GAS EXCHANGE AFTER EARLY FAILED VITRECTOMY SURGERY FOR MACULAR HOLE

Background: Vitrectomy surgery with fluid-gas exchange and prone posit ioning has been shown to close macular holes and improve vision. In th ose eyes that have failed surgery, repeat vitrectomy has been advocate d. As an alternative, the authors performed an outpatient postoperativ e fluid-gas exchange on eyes when the macular hole failed to close aft er vitrectomy surgery. Methods: The authors reviewed all cases of fail ed vitrectomy surgery for macular holes that underwent a postoperative fluid-gas exchange. Eyes were considered to have failed initial surge ry if a rim of subretinal fluid surrounded an open full-thickness macu lar hole. Results: Twenty-three consecutive eyes underwent outpatient fluid-gas exchange 1 week to 8 weeks after vitrectomy surgery. In 17 e yes (74%), fluid-gas exchange resulted in flattening and closure of th e macular hole. In all 17 eyes, visual acuity improved 2 or more lines , with 8 (35%) of the 23 eyes achieving 20/50 or better visual acuity. Conclusions: Postoperative fluid-gas exchange may achieve successful closure of macular holes and improve vision in eyes that have failed s urgery for full-thickness macular holes and should be considered as a cost-effective alternative to repeat vitrectomy.