Subretinal fluid application to close a refractory full thickness macular hole

BACKGROUND: To close a refractory full thickness macular hole (FTMH) by adjacent subretinal fluid application to release the elastic retina from the retinal pigment epithelium (RPE). CASE PRESENTATION: A 83 years old patient presented an old FTMH with a diameter of 1444 μm. After confirming intraoperatively the complete release of the epiretinal membrane around the FTMH, we installed 3 small subretinal blebs around the hole, to release the adjacent retina from the RPE. The mobilized retina was gently moved towards the macular center. A silicone oil tamponade was installed to secure a proper healing and observation of the FTMH. The closure of the 1444 μm FTMH was seen on indirect ophthalmoscopy and confirmed by OCT 5 days after surgery by restoring the retinal architecture. A late reopening was not apparent at the postoperative observations. Visual acuity improved from hand motion to 20/200 at 4 weeks postoperative. CONCLUSION: Although FTMH develop by epiretinal tangential traction, large FTMH may persist even after complete release of its epiretinal traction. Subretinal fluid application may release the flexible retina from the RPE to achieve a relocation at the central fovea facilitating an anatomical closure of the macular hole.