DR. ASHISH MARKAN

Abstract

An 11-year-old male child who presented to us with a large post-traumatic full thickness macular hole (1100 um) in the left eye, underwent pars plana vitrectomy with multilayered ILM flaps and gas tamponade. Fundus examination at postoperative day 10 showed persistence of large MH. OCT findings were confusing of a type 2 closure versus failed MH and there was no evidence of any ILM flaps of the previous surgery. The disappearance of ILM flaps within 10 days was surprising and the patient was eventually taken up for resurgery. Restaining with BBG dye during the second surgery, we found that ILM flaps had actually unfolded back from the hole and re-adhered to the retinal surface, giving an appearance of fovea sparing ILM peeling. The flaps were then again lifted using ILM forceps, repositioned into the macular hole under perfluoro-n-octane (PFO) and 14% C3F8 was given. Postoperatively, BCVA improved to 6/24, the hole was clinically closed and OCT revealed a type 1 closure.