Microbubble in the hole: a rare cause of failed macular hole surgery?

PURPOSE To present a failed macular hole surgery with gas microbubble retention within the hole. METHODS A 68-year-old female patient with a Stage 2 macular hole underwent vitrectomy with removal of posterior hyaloid and 12% C3F8 gas injection. Because the macular hole was Stage 2 and posterior hyaloid was observed to be firmly attached over the macular area, no attempt was made for peeling of internal limiting membrane. Postoperatively, the patient was instructed to keep a facedown posture for 1 week. At 1-month visit, ophthalmoscopy revealed a tiny gas bubble filling the macular hole that failed to close. RESULTS The patient underwent a repeat vitrectomy in which internal limiting membrane was peeled, and the eye was filled with 20% SF6. At 2-week follow-up visit, the hole was observed to be closed. CONCLUSION The reason for the macular hole nonclosure in this case may be the lack of internal limiting membrane peeling in the first operation. However, the authors believe that microbubble localized within the hole might have contributed to the failure.