In-Office Sulfur Hexafluoride (SF6) Injection to Close Recently Operated or Reopened Macular Holes: A Minimal Approach Technique.

To describe an in-office minimal approach technique for closing recently operated full thickness macular holes (FTMH), when closure was not fully achieved or there was macular hole re-formation, without performing another pars plana vitrectomy (PPV). Retrospective case series study. Nine patients were included in this case series. All patients were diagnosed with FTMH characterized by a decrease in visual acuity (VA) and metamorphopsias. All patients initially underwent a standard PPV procedure with 20% sulfur hexafluoride (SF6) injection. After 1-16 weeks, no closure or reformation of the macular hole was observed. Fluid-SF6 exchange was performed in the slit lamp, with the aim of injecting a 50% gas bubble of pure SF6 into the vitreous cavity, according to a minimally invasive in-office technique. Postoperatively, all patients achieved successful macular hole closure and VA showed an average improvement of approximately 4 lines on the EDTRS logarithm of the minimum angle of resolution (logMAR) chart. In particular, the mean corrected distance visual acuity improved from 0.99 ± 0.27 logMAR to 0.33 ± 0.23 logMAR (P = 0.03). The minimal surgical in-office technique of SF6 injection for the management of reopened macular holes after a recent PPV procedure shows promising results.

Anterior Chamber Sulfur Hexafluoride (SF6) Injection for the Management of Postsurgery Hypotony in Glaucoma Patients.

PURPOSE: The purpose of this article was to describe a new technique involving the injection of sulfur hexafluoride (SF6) gas in the anterior chamber (A/C) for the management of hypotony in patients with previous glaucoma surgery. MATERIALS AND METHODS: Seven patients were included in this prospective case series. All patients had advanced glaucoma that was managed surgically either by trabeculectomy (6 patients) or Ahmed valve (1 patient). All patients presented with intraocular pressure (IOP) <7 mm Ηg, shallow A/C, and ultrasound images of choroidal detachment and ciliary body detachment. Patients' hypotony was treated by 0.4 to 0.6 mL of 100% pure SF6 injection in the A/C followed by supine posture. The purpose of this injection was dual: to displace the ciliary body to its normal position and restore aqueous humor normal production, and to block aqueous humor outflow through bubble formation, causing an increase in IOP. RESULTS: Surgical technique was successful in all 7 patients with IOP normalization (>10 mm Hg) and A/C depth increase within the first week after surgery. CONCLUSION: A new surgical technique of SF6 injection in the A/C for patients with choroidal detachment and hypotony shows promising results.