Sub-Perfluorocarbon Ophthalmic Viscoelastic Injection (SPOT) technique for macular hole retinal detachment surgery

Purpose: Macular hole with retinal detachment (MHRD) often presents in highly myopic eyes and is one of the most challenging macular condition. Previously, we reported the preliminary results of using the sub-perfluorocarbon liquid ocular viscoelastic device injection (SPOT) technique to facilitate MHRD surgeries in eight eyes. The purpose of this extended study is to report the outcomes in a larger cohort with a longer follow-up. Methods: A retrospective case series of 20 eyes with MHRD that underwent vitrectomy with internal limiting membrane (ILM) peeling and inverted flap (16 eyes, 80%), ILM insertion (3 eyes, 15%), or ILM free flap (1 eye, 5%) assisted by the SPOT technique in a tertiary referral center. The main outcomes measures were best-corrected visual acuity (BCVA) and the final hole closure and reattachment of the macula accessed by spectral-domain optical coherence tomography. Results: The mean axial length of was 28.17 ± 3.0 mm (range, 20.61–33.10 mm) and the mean follow-up time was 382 ± 214 days. After vitrectomy with SPOT technique, primary hole closure was noted in all 20 eyes. In two eyes (10%) the hole reopened but the retina remained attached. In another two eyes, minimal subretinal fluid persisted despite hole closure. The final hole closure and retinal reattachment rates were both 90% (18 eyes). At the last visit, 14 eyes (70%) had improved BCVA and the logMAR BCVA improved from 1.44 ± 0.47 (Snellen 20/550) to 1.12 ± 0.59 (Snellen 20/260). No significant difference was observed in the functional and anatomical outcomes between MHRD within the arcades (9 eyes, 45%) and beyond the arcades (11 eyes, 55%). Conclusions: For macular holes with retinal detachment, SPOT successfully assisted different internal limiting membrane flap techniques and achieved 90% macular hole closure and 90% retinal reattachment rates. In 90% of the eyes, the vision stabilized or improved. SPOT technique has a gentle learning curve and allows surgeons to manipulate the ILM flap with ease, which is beneficial in challenging surgeries such as macular holes accompanied with a detached retina. Trial Registration: Retrospectively registered.