Evolution and successful management of a large postvitrectomy macular hole

We report the successful closure of a large postvitrectomy macular hole by temporal extension of internal limiting membrane (ILM) peeling. A 25-year-old man underwent pars plana vitrectomy, ILM peeling, and perfluoropropane gas tamponade for optic pit with chronic macular schisis and outer lamellar hole. The macular schisis deroofed into a large, full-thickness macular hole postoperatively. Optical coherence tomography revealed the horizontally oval shape of the secondary macular hole (658 × 824 μ). The best-corrected visual acuity (BCVA) was 20/200. Since ILM had already been peeled and the macular hole was widest horizontally, we combined a repeat gas tamponade with temporal extension of the ILM rhexis. Closure of the large macular hole with no central defect was observed and documented after the gas fill of the vitreous cavity was reduced sufficiently. BCVA remained unchanged for the initial months but gradually improved to 20/63 by the final follow-up visit at 5 years. A simple horizontal extension of ILM peel – in line with the shape of the hole – with repeat gas tamponade successfully closed a large secondary macular hole with progressive visual improvement.