title: Additional gas injection after failed macular hole surgery with internal limiting membrane peeling.
abstract: OBJECTIVE
  To report the efficacy of additional intravitreal gas injection in eyes where primary failure occurred following apparently successful macular hole surgery.
  
  
  METHODS
  Patients presenting with macular hole underwent a primary surgical procedure consisting of vitrectomy with phacoemulsification and intraocular lens implantation. The internal limiting membrane was stained with indocyanine green and peeled. At the end of this manoeuvre a fluid-gas exchange was performed and the macular hole tamponaded with 20% sulphur hexafluoride. The patients were instructed to assume a face-down position for 12 h per day until the macular hole closed. In those cases where primary closure was not achieved, an additional quantity of 20% sulphur hexafluoride was injected into the vitreous cavity via a 27-gauge needle connected to a 5-mL syringe. The patients were instructed to assume the same position.
  
  
  RESULTS
  A total of 40 eyes from 40 consecutive patients underwent primary macular hole surgery. The macular hole was not successfully closed in seven eyes and a further gas injection was made in these eyes. This additional procedure led to macular hole closure in all cases within a mean of 4.1 days. Visual acuity improved in all seven eyes, and the final visual outcomes were no worse than those eyes that had successful primary closure.
  
  
  CONCLUSIONS
  Additional gas injection is an effective treatment for eyes with open holes following unsuccessful primary surgery.
authors: Toyama Prefectural Central Hospital, Toyama, and Kanazawa University Graduate School of Medical Science, Japan. tsuyoshiiwase@aol.com
authors: Takeshi
authors: T
authors: Iwase
authors: Kazuhisa
authors: K
authors: Sugiyama
mesh_terms: D000368:Aged; D001485:Basement Membrane / Q000601:surgery; D004396:Coloring Agents; D003131:Combined Modality Therapy; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007267:Injections; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D016684:Prone Position; D012160:Retina / Q000473:pathology; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery*; D013459:Sulfur Hexafluoride / Q000008:administration & dosage*; D041623:Tomography, Optical Coherence; D017211:Treatment Failure; D014821:Vitrectomy
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green; D013459:Sulfur Hexafluoride