Posterior Pole Detachment Technique for the Management of Full Thickness Macular Hole

Full thickness macular holes have an estimated prevalence of 1/3300, with more than fifty percent occurring in patients aged 65-74 years [1]. The vast majority (>80%) are idiopathic, with smaller proportions occurring in the setting of trauma, inflammation, and myopia. Furthermore, it is estimated that even fewer (less than 1% of full thickness macular holes (FTMH)) have been reported in association with both macular on and off retinal detachments treated with vitrectomy or scleral buckling alone [2,3]. Once FTMH develops few spontaneously close, with the majority requiring vitrectomy, ILM peeling and gas tamponade. For most macular holes this approach usually results in successful hole closure and improving vision [4-6]. However, patients with large (>400μm), chronic, full thickness macular holes are the exception. In this subgroup there is a significantly higher surgical failure rate and poorer visual outcomes with reoperation required [7-9]. The poor surgical outcomes in this subgroup of macular hole patients have stimulated the consideration of novel surgical approaches to treat this clinically important subset of patients. In recent years these modifications have included massaging the retina around the hole [10], using an inverted flap of ILM remnant to cover the macular hole [11] and laser photocoagulation at the centre of the macular hole before vitrectomy [12]. In addition attempts have been made to close these large full thickness defects by inducing a posterior pole detachment by injection of sub-retinal fluid using a 41 gauge needle, the ‘retina expansion technique’ [13]. The current study reports our experience with the retina expansion technique in patients with large idiopathic, traumatic and post rhegmatogenous retinal detachment (RRD) full thickness macular hole.