Advancing Macular Hole Surgery Advancing Macular Hole Surgery
STEVE CHARLES, MD Macular holes were untreatable until Kelly and
Wendel1 developed the concept of core vitrectomy followed by
fluid-gas exchange using an iso-expansive mixture of air and SF6
or C3F8 gas. Their goal was to reattach the cuff of subretinal
fluid around a full-thickness macular hole and thereby eliminate
the relative scotoma that surrounds the absolute scotoma.
Serendipitously, they soon discovered that the macular hole
often closed with remarkable improvement in vision. Leading
surgeons initially discounted this discovery, but fortunately it
has become the standard of care. The prevailing thought was that
substantial neural tissue was avulsed by a posterior vitreous
detachment; an operculum was often seen, seemingly validating
this notion. Examination of surgically removed operculums using
the electron microscope revealed very little neural tissue; most
of the operculum proved to be glial tissue, ex plaining why
substantial visual imp