Minimal vitrectomy for macular holes: Minimal vitreous removal, minimal internal limiting membrane peeling/flap and no tamponade

Purpose: To evaluate the safety and effectiveness of minimal posterior vitrectomy combined with minimal internal limiting membrane (ILM) peeling and the injection of DisCoVisc under perfusion to fix the inverted single flap of the ILM for the closure of macular hole (MHs) without gas tamponade. Methods: Minimal vitrectomy was performed on 12 eyes of 12 patients presenting with MHs. During the surgical procedure, only vitreous gel between vascular arcades was removed. The DisCoVisc was then injected under perfusion to fix the inverted ILM single flap. The vitreous cavity was tamponaded with balanced salt solution (BSS), and patients kept a non-strict face-up position for 24 hours postoperatively. Results: By the last follow-up, all 12 eyes (100%) had completely closed MH. Optic coherent tomography (OCT) revealed that 10 eyes exhibited U-shaped closure, while 1 eye showed V-shaped closure and another demonstrated W-shaped closure. The average area of ILM peeling was 7.76 ± 2.14 mm 2 , and ILM flap covering the macular hole was 4.80 ± 1.29 mm 2 . Preoperatively, the BCVA was 1.26 ± 0.52 LogMAR, which improved to 0.57 ± 0.37 LogMAR at the last follow-up ( P =0.001). The IOP on the first postoperative day was 17.46 ± 9.34 mmHg, comparable to the preoperative IOP of 15.49 ± 2.94 mmHg ( P =1.000). Last follow-up, the IOP (12.48 ± 2.45 mmHg) was lower than preoperative( P =0.001). Conclusion: This technique is not only straightforward and time-efficient but also effectively closes MHs and enhances postoperative vision, all while avoiding the discomfort associated with gas tamponade and face-down position.