Pars plana vitrectomy with air tamponade for the treatment of medium-large macular holes.

Background: To evaluate the surgical outcomes of pars plana vitrectomy (PPV) with air tamponade in medium-large macular holes (MHs).

Methods: Data for 26 eyes of 26 consecutive patients with medium-large full-thickness MHs (> 400 μm) who underwent PPV, internal limiting membrane (ILM) peeling, and sterile air tamponade were studied retrospectively. Best-corrected visual acuity and the closure rate were noted. The follow-up period was one to 20 months (median, four months).

Results: The age range of the patients was 53-73 years (median, 65 years). The mean minimum diameter of the MHs was 550 ± 99 μm. Prior to surgery, 10 eyes (38 per cent) were stage three, and 16 eyes (62 per cent) were stage four. The pre-operative symptom duration ranged from one month to 24 months (median, four months). Twenty-four MHs (92.3 per cent) were successfully closed after a single operation. Two (7.7 per cent) patients had a persistent MH. The average visual acuity, calculated as the logarithm of the minimal angle of resolution, improved from 1.44 ± 0.45 pre-operatively to 0.54 ± 0.29 at the end of the follow-up period (p < 0.001, paired t-test).

Conclusion: Vitrectomy with ILM peeling and sterile air tamponade is an effective and safe surgical technique for managing medium-large MHs with a shorter history and does not require intravitreal long-acting gas tamponade while maintaining a long-term, face-down position.