Treatment of reopened macular hole after vitrectomy by laser and outpatient fluid-gas exchange

Objective: This study aimed to assess a new nonsurgical treatment for patients who have previously undergone vitrectomy for macular hole with either persistent or reopened holes. Design: A prospective, noncomparative, consecutive case series. Participants: Fifteen patients (15 eyes) were studied. Intervention: Patients were treated by an outpatient method consisting of laser photocoagulation to the foveal pigment epithelium followed by fluid-gas exchange with 20% perfluoropropane gas and prone positioning. Patients without known allergy were treated with two doses of oral Diamox (250 mg) and ciprofloxacin (500 mg). Main Outcome Measures: Visual acuity, intraocular pressure, anatomic status of the macular hole, and cataract were the principal outcome measures studied. Results: Thirteen of 15 macular holes were closed successfully with 1 or more procedures. All patients with macular hole closure achieved two lines or greater of vision improvement on Snellen testing. Three patients (20%) achieved 20/40 and nine (60%) achieved 20/80 or better. Three patients required more than one procedure. Four patients developed mild transient ocular hypertension. Conclusions: The combination of office-based outpatient fluid-gas exchange and laser appears to be a safe and cost-effective alternative to repeat surgery in selected patients with persistent or reopened macular holes after vitrectomy, in whom there are no visible epiretinal membranes, or in whom return to the operating room is undesirable for medical or personal reasons.