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    Paracentral retinotomy facilitates closure of large, resistant macular hole

    Most macular hole surgeries end successful with achievement of hole closure.  However, there is a small percentage, ranging from 3% to 10%, of large macular holes that will not close despite peeling of the internal limiting membrane (ILM) and instructing the patients to maintain a face-down position with injection of a long-acting gas, such as perfluoropropane (C3F8). 

    Recognition of this problem resulted in an innovative approach for closing persistent macular holes after the primary surgery has failed by creating a separate paracentral retinotomy in the nasal macula. Michael S. Tsipursky, MD, described the rationale for trying this treatment approach. 

    “This technique is similar to a relaxing incision,” said Dr. Tsipursky, who is in private practice in Effingham, IL.

    He described six patients (6 eyes) who had large macular holes exceeding 400 μm. The patients all had undergone at least one surgery to close the holes. The rationale in creating a separate paracentral hole to address these large macular holes is that the amount of tissue in the nasal macula might be increased with the creation of a round retinotomy. 

    Dr. Tsipursky creates the hole using endocautery and aspiration with a soft-tipped cannula. In these eyes, the ILM had been peeled and vitrectomies had been performed in the previous surgeries. C3F8 gas was injected into the eyes. 

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