A 62-year-old woman with a full-thickness idiopathic macular hole (stage 3, diameter over 400 microns) and visual acuity of 6/36 undergoes surgery. Which operative steps give the best chance of anatomical closure?
- A Vitrectomy with silicone oil tamponade and no membrane peeling
- B Vitrectomy with internal limiting membrane peeling and gas tamponade ✓
- C Pneumatic retinopexy with face-down positioning
- D Intravitreal anti-VEGF injection followed by observation
Correct answer: B. Vitrectomy with internal limiting membrane peeling and gas tamponade
Explanation
Standard surgery for a full-thickness idiopathic macular hole is pars plana vitrectomy with removal of the posterior hyaloid, internal limiting membrane peeling to relieve tangential traction, fluid-air exchange and gas tamponade followed by postoperative face-down positioning. ILM peeling substantially raises closure rates compared with vitrectomy alone. Silicone oil is reserved for special situations and gives lower closure rates than gas, pneumatic retinopexy is a procedure for rhegmatogenous detachments, and anti-VEGF agents have no role in closing a full-thickness hole.
Reference: Kanski's Clinical Ophthalmology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.