Texas Retina’s Rene Y. Choi, MD, PhD, recently published a case report in the medical journal Retinal Cases & Brief Reports describing a surgical technique he developed to treat macular holes that fail to close after initial surgery. He co-authored the report with Anirudh Gadicherla and Amirmohammad Shafiee, two medical students he mentors at Texas Christian University’s Anne Burnett School of Medicine.
Overcoming a Challenge: A New Surgical Technique
A macular hole is a full thickness opening in the center of the retina that can cause significant loss of central vision. Treatment typically involves a surgical procedure, in which the surgeon peels away a thin tissue layer on the retinal surface called the internal limiting membrane (ILM) and places a gas bubble in the eye to help the hole close.
That works well for most holes, but not all. In larger holes, up to 44 percent can remain open after a first operation. The difficulty is that the ILM near the center of the retina has already been removed, so the tissue a surgeon would normally use to help bridge the hole is gone.
“When the hole stays open after initial surgery, there is nothing left near the fovea to work with, and the options get thin,” explains Dr. Choi. “Our approach harvests several small grafts of that same membrane from farther out where it was never touched, then transfers and layers them into the hole while working underneath a heavy liquid bubble. The bubble holds everything in place through the stage of the operation where grafts usually shift or wash out.”
In the published case report, Dr. Choi describes the treatment of a 70-year-old woman who had a persistent, large, full-thickness macular hole in her right eye two months after undergoing pars plana vitrectomy surgery with an ILM peel.
Using the new surgical technique, Dr. Choi was able to achieve complete closure of the macular hole. Five months after surgery, the patient’s best-corrected visual acuity in the treated eye had improved from 20/200 to 20/50.
Click HERE to read the full case report.
About Dr. Choi
Dr. Choi joined Texas Retina in 2020 and cares for patients at Texas Retina’s Denton and Frisco offices. He is passionate about developing and refining advanced surgical techniques for complex retinal conditions with the goal of improving patient outcomes.
Click HERE to learn more about him.