VITRECTOMY FOR REFRACTORY MACULAR HOLE

In Brief Purpose: To report two cases of the treatment of refractory macular hole. Methods: A retrospective case report of two patients who underwent vitrectomy for refractory macular hole. Results: Two patients underwent pars plana vitrectomy for refractory macular holes. However, the surgical methods differed in the two patients depending on whether the internal limiting membrane (ILM) remained or not. In the patient with the remnant ILM, pars plana vitrectomy, inversion of the remaining ILM flap, air–fluid exchange, and 5% C3F8 gas tamponade were performed. In the other case with no remaining ILM, pars plana vitrectomy, inversion and release of the margin of the macula hole, combined with autologous platelet concentrate, air–fluid exchange, and 5% C3F8 gas tamponade were performed. In both cases, good anatomical outcomes were achieved postoperatively. Conclusion: Depending on whether the ILM remains or not, one of these two new surgical procedures can be selected. This protocol can yield positive surgical results. Depending on whether internal limiting membrane is present or not, the proper technique for refractory macular hole can be selected. If the internal limiting membrane is present and adequate, the “inverted internal limiting membrane flap” technique should be selected. However, if the internal limiting membrane is completely absent or inadequate, the “inversion of hole margin” technique should be used.