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RETINA EXPANSION TECHNIQUE FOR MACULAR HOLE APPOSITION REPORT 2: Efficacy, Closure Rate, and Risks of a Macular Detachment Technique to Close Large Full-Thickness Macular Holes

Wong, Roger, FRCOphth*,†; Howard, Catherine, MBBS*; Orobona, Giancarlo, Dell'aversana, MD*,‡

doi: 10.1097/IAE.0000000000001705
Original Study

Purpose: To describe the safety and efficacy of a technique to close large thickness macular holes.

Methods: A consecutive retrospective interventional case series of 16 patients with macular holes greater than 650 microns in “aperture” diameter were included. The technique involves vitrectomy, followed by internal limiting membrane peeling. The macula is detached using subretinal injection of saline. Fluid–air exchange is performed to promote detachment and stretch of the retina. After this, the standard fluid–air exchange is performed and perfluoropropane gas is injected. Face-down posturing is advised. Adverse effects, preoperative, and postoperative visual acuities were recorded. Optical coherence tomography scans were also taken.

Results: The mean hole size was 739 microns (SD: 62 microns; mean base diameter: 1,311 microns). Eighty-three percent (14 of 16) of eyes had successful hole closure after the procedure. At 12-month follow-up, no worsening in visual acuity was reported, and improvement in visual acuity was noted in 14 of 16 eyes. No patients lost vision because of the procedure.

Conclusion: It is possible to achieve anatomical closure of large macular holes using RETMA. No patients experienced visual loss. The level of visual improvement is likely limited because of the size and chronicity of these holes.

RETMA is a technique in closing large full-thickness macular holes using the internal elastic property of the retina. This article reports most patients achieving some gain in visual acuity.

*Vitreoretinal Service, Guy's and St. Thomas' Hospital NHS Foundation Trust, Ophthalmology Department, St. Thomas' Hospital, London, United Kingdom;

School of Medicine, Kings College London, London, United Kingdom; and

Department of Ophthalmology, Second University of Naples, Caserta, Naples, Italy.

Reprint requests: Roger Wong, FRCOphth, Guy's and St. Thomas' Hospital NHS Foundation Trust, Ophthalmology Department, St. Thomas' Hospital, Lambeth Palace Road, London SE1 2PD, United Kingdom; e-mail:

None of the authors has any financial/conflicting interests to disclose.

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© 2018 by Ophthalmic Communications Society, Inc.