Intraocular pressure after myopic laser refractive surgery measured with a new Goldmann convex prism: correlations with GAT and ORA.

BACKGROUND: The purpose of this study is to describe measurements using a newly developed modified Goldmann convex tonometer (CT) 1 year after myopic laser refractive surgery. Intraocular pressure (IOP) measurements were compared with IOP values obtained by Goldmann applanation tonometer (GAT), and Ocular Response Analyzer (ORA). METHODS: Prospective double-masked study performed on thirty eyes of thirty patients that underwent laser in situ keratomileusis (LASIK; n = 19) or photorefractive keratectomy (PRK; n = 11). IOP was measured before and 3 and 12 months after surgery. Intraclass correlation coefficient (ICC) and Bland-Altman plot were calculated to assess the agreement between GAT, CT, IOPg (Goldmann-correlated IOP) and IOPcc (corneal-compensated IOP) from ORA. RESULTS: Twelve months after LASIK, IOP measured with CT showed the best correlation with IOP measured with GAT before surgery (GATpre) (ICC = 0.886, 95% CI: 0.703-0.956) (15.60 ± 3.27 vs 15.80 ± 3.22; p < 0.000). However, a moderate correlation was found for IOP measured with IOPcc and CT 12 months after LASIK (ICC = 0.568, 95% CI: - 0.185 - 0.843) (15.80 ± 3.22 vs 12.87 ± 2.77; p < 0.004). Twelve months after PRK, CT showed a weak correlation (ICC = - 0.266, 95% CI: - 3.896 - 0.663), compared to GATpre (17.30 ± 3.47 vs 16.01 ± 1.45; p < 0.642), as well as poor correlation (ICC = 0.256, 95% CI: - 0.332 - 0.719) with IOPcc (17.30 ± 3.47 vs 13.38 ± 1.65; p < 0.182). CONCLUSIONS: Twelve months after LASIK, IOP measured with CT strongly correlated with GAT before surgery and could therefore provide an alternative method for measuring IOP after this surgery. More studies regarding this new convex prism are needed to assess its accuracy.

VITRECTOMY FOR ENDOPHTHALMITIS IN EYES WITH OSTEOKERATOPROSTHESIS.

PURPOSE: To analyze functional and anatomical results of pars plana vitrectomy (PPV) to treat endophthalmitis in eyes with osteokeratoprosthesis. METHODS: An observational, retrospective study of five eyes suffering from endophthalmitis, after an osteokeratoprosthesis implantation, which underwent PPV associated with intravitreal antibiotics. The minimum follow-up after PPV was 6 months. A descriptive study and a Kaplan-Meier survival analysis for anatomical (attached retina during the follow-up) and functional success (visual acuity ≥20/400) were performed. RESULTS: Best-corrected visual acuity during the final follow-up was 20/100 in 1 case (20%), hand movement in another case (20%), and no light perception in 3 cases (60%). The anatomical survival rates were recorded at 80%, 60%, and 40% at 1, 6, and 8 months respectively, and this last value was maintained at 12 months after PPV. The functional survival rates were recorded at 40% and 20% at 1 month and 8 months, respectively, and this last value was maintained at 12 months after PPV. CONCLUSION: Endophthalmitis in eyes with previous osteokeratoprosthesis is a very severe complication with a reserved prognosis. Pars plana vitrectomy associated with intravitreal antibiotics leads to maintaining or increasing visual acuity in a small proportion of patients who otherwise would end up blind.

Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit.

PURPOSE: To compare the anatomical and functional outcome of adjuvant pars plana vitrectomy (PPV) procedures using the techniques of translocation of an internal limiting membrane (ILM) flap and transplantation of an inverted ILM flap for the treatment of chronic and/or refractory optic disc pit (ODP) maculopathy. METHODS: In this prospective interventional case series study, 9 patients (9 eyes) with chronic and/or refractory ODP maculopathy underwent PPV with either translocation of an ILM flap or transplantation of an inverted ILM flap as adjuvant techniques along with gas tamponade. The anatomical success, rates of macular reattachment, and visual improvement were assessed. RESULTS: The mean preoperative central retinal thickness (CRT) was 723.4 µm (range: 366-1,151). The mean postoperative CRT was 398.1 ± 212.2 µm (range: 210-758). An increased preoperative CRT was associated with a lower chance of postoperative reattachment of the macula (p = 0.047). The overall reattachment rate at the end of the follow-up period was 56% (n = 5). The mean preoperative visual acuity (logMAR unit [Snellen acuity]) was 0.48 (20/60) (range: 1.30 [20/400] to 0.10 [20/25]). The mean change in best corrected visual acuity (BCVA) was 0.48 ± 0.233 logMAR units (approx. 3 lines of visual improvement). CONCLUSIONS: ILM flap techniques are logical and straightforward approaches as adjuvants to PPV treatment of ODP maculopathy. They could be viable adjuvant treatments for improvement in BCVA and CRT in patients with ODP maculopathy.

RESULTS OF RETINAL DETACHMENT SURGERY IN EYES WITH OSTEO-KERATOPROSTHESIS.

PURPOSE: To evaluate the anatomical and functional results of pars plana vitrectomy in eyes with osteo-keratoprosthesis, who have suffered retinal detachment. METHODS: An observational, retrospective study of 18 eyes which underwent pars plana vitrectomy for retinal detachment after an implantation of an osteo-keratoprosthesis, with a minimum of 1-year follow-up. A descriptive study and a Kaplan-Meier survival analysis for anatomical and functional success were performed. Anatomical success was defined as an attached retina at the end of vitreoretinal surgery with no redetachment during the follow-up. Functional success was defined as a postoperative visual acuity of more than or equal to 20/400. RESULTS: The overall rate of anatomical success was 56%, and the anatomical survival rates were 67% and 53% at 6 months and 12 months, respectively, maintaining this last value at 24 months after pars plana vitrectomy. The overall rate of functional success was 17%, and the functional survival rates were 83%, 39%, and 14% at 6 months, 12 months, and 24 months after pars plana vitrectomy, respectively. The most frequent complication after retinal surgery was retroprosthetic membrane (33%). CONCLUSION: Despite the reserved prognosis and the severe complications, vitrectomy represents a valid method for treating retinal detachment in patients with osteo-keratoprosthesis, with good anatomical results but poor visual acuity.

Long-term visual outcomes and rehabilitation in Usher syndrome type II after retinal implant Argus II.

BACKGROUND: The aim of this article is to describe visual outcomes and posterior rehabilitation of the first Usher syndrome type II (USH2) patient receiving an Argus II (®) prosthesis. CASE PRESENTATION: We present a case of a USH2 patient who underwent Argus II prosthesis surgery at the age of 53. He had hearing loss from birth and presented a very poor visual field with good light perception. He communicated through sign language translated by his interpreter, who explained all the information regarding the surgical procedure and who assisted in the posterior visual therapy. Sixteen months after surgery, the patient communicates more fluently with sign language and is able to identify letters with high contrast over 6 cm and words up to four letters. CONCLUSIONS: This is the first case described in the literature of a USH2 patient receiving an Argus II prosthesis This is an alternative treatment for USH2 patients, whose interpreters are essential in the selection process and subsequent rehabilitation after surgery.

Reduction of foveal bulges and other anatomical changes in fellow eyes of patients with unilateral idiopathic macular hole without vitreomacular pathologic changes.

PURPOSE: To compare the foveal characteristics in fellow eyes (FE) of patients with unilateral idiopathic macular hole without vitreomacular pathologic changes with eyes of healthy controls. METHODS: Forty-seven FE and 52 eyes of 52 age- and sex-matched healthy controls were studied. Quantitative assessment of the dome-shaped appearance of the hyperreflective lines that represent external limiting membrane (ELM_bulge) and inner outer segment junctions (IS/OS_bulge) were made by optical coherence tomography (OCT) images. Inner retinal complex thickness (IRCT) was quantitatively assessed at 1000 and 2000 µm of the foveal center in nasal and temporal quadrants. Presence of alterations in the inner retinal outer layers and central foveal thickness (CFT) were also analyzed. RESULTS: Significantly lower ELM_bulge (p < 0.0001; Mann-Whitney test) and IS/OS_bulge (p < 0.001; student t test) and higher cases with COST alterations, expressed as a diffuse line (p < 0.006; Chi2 test) were found in FE than control eyes. IRCT were significantly reduced in FE at all the studied locations when comparing to control eyes (p < 0.05; student t test), maintaining anatomical proportionality among locations. CONCLUSION: FE without pathologic vitreomacular interactions seems to present some central cone alterations that may be related to other causes than vitreomacular traction.

AUTOLOGOUS RETINA TRANSPLANTATION FOR TREATMENT OF REFRACTORY DOUBLE FULL-THICKNESS MACULAR HOLE IN ALPORT SYNDROME.

PURPOSE: To report the structural and functional outcomes of autologous neurosensory retinal transplantation for closure of refractory double full-thickness macular hole in a patient diagnosed with Alport syndrome. METHODS: Patient with previous pars plana vitrectomy and a failed macular hole surgery (internal limiting membrane removal) underwent pars plana vitrectomy and autologous neurosensory retinal flap transplantation with silicone oil tamponade. Follow-up was performed after one year. The anatomic outcomes were evaluated mainly by fundus examination, optical coherence tomography (OCT), and microperimetry (MAIA). The functional changes were evaluated comparing best-corrected visual acuities preoperative and 1 year after surgery. RESULTS: A 35-year-old man with progressive visual loss of two years of evolution presented a double full-thickness macular hole in the left eye. After retinal flap transplantation, the macular hole appeared successfully closed during the entire follow-up. Integration of both retinal flaps into the surrounding retina and regeneration of the external retinal layers were observed in optical coherence tomography. Best-corrected visual acuities improved from 20/200 preoperatively to 20/80 one-year postoperatively. CONCLUSION: Pars plana vitrectomy combined with autologous neurosensory retinal flap transplantation is an effective option to achieve the anatomic closure of recurrent double full-thickness macular hole and significant visual recovery in Alport syndrome.

Vitrectomy without face-down posturing for idiopathic macular holes.

PURPOSE: To report the results of vitrectomy with internal limiting membrane peeling and C3F8 tamponade for macular hole without postoperative face-down posturing in 208 eyes. METHODS: The study included 208 eyes on an uncontrolled retrospective review, undergoing pars plana vitrectomy with trypan blue-assisted internal limiting membrane peeling and C3F8 tamponade, without subsequent face-down posturing. All patients were followed-up at 1 day, 1 week, 3 months, and 12 months postoperatively. Biomicroscopy and optical coherence tomography were used to assess macular hole closure at 1 day, 1 week, 3 months, and 12 months postoperatively. Pre- and postoperative visual acuity by Snellen chart was compared. RESULTS: In 208 eyes with idiopathic macular hole, preoperative mean visual acuity was 20/200 and final visual acuity was 20/40 (P = 0.00017). Anatomic macular hole closure rate was 81.3%. CONCLUSION: In agreement with published studies, combined phacovitrectomy without face-down posturing after macular hole surgery seems effective and safe, showing anatomical improvement and favorable best-corrected visual acuity. Isolating the macula from vitreous fluid with a large long-lasting gas-fill may render postoperative posturing unnecessary. Eliminating face-down posturing may increase patient acceptance and compliance.

Endodiathermy plus photocoagulation as treatment of sclerotomy site vascularization secondary to pars plana vitrectomy for proliferative diabetic retinopathy.

PURPOSE: To evaluate the results of surgery with pars plana vitrectomy (PPV), endodiathermy of sclerotomy site fibrovascularization and adjuvant photocoagulation of the peripheral retina to the pars plana as treatment of recurrent vitreous hemorrhage secondary to PPV for proliferative diabetic retinopathy (PDR). METHODS: Tertiary care center, Barraquer Center of Ophthalmology, Barcelona, Spain. Prospective interventional study of 14 eyes of 14 consecutive patients aged 20 years to 47 years with recurrent vitreous hemorrhage because of sclerotomy site neovascularization secondary to PPV for PDR. All patients were treated by cataract, or transparent lens, extraction with intraocular lens implantation plus 20-gauge PPV of the vitreous base, including incarcerated vitreous of the sclerotomy site, together with endodiathermy of sclerotomy site fibrovascular tissue and adjuvant photocoagulation to the pars plana. Preoperative evaluation was performed by 20-MHz, high-resolution, anterior-segment ultrasonography of the neovascularized sclerotomy sites, pre- and postoperative visual acuity (logarithm of the minimum angle of resolution), and postoperative rebleeding rates. RESULTS: Recurrent vitreous hemorrhage appeared 8 ± 4 months after the initial PPV for PDR. Ten (71%) patients had isolated vascularization of a single sclerotomy site and 4 (29%) had vascularization of 2 sclerotomy sites. Nine of the 18 vascularized sites (50%) corresponded to optical fiber sclerotomies, 7 (39%) to vitreotome, and 2 (11%) to infusion sclerotomies. All the neovascularized sclerotomies presented sentinel vessels in the anterior segment. No patient showed postoperative recurrent vitreous hemorrhage during follow-up of 23 ± 10 months; all showed improved visual acuity, from initial 2.23 (±1.13 standard deviation) to final 0.23 (±0.09 standard deviation). CONCLUSION: According to our study, the technique of choice for the treatment of recurrent vitreous hemorrhage secondary to PPV for PDR is endodiathermy of sclerotomy site fibrovascularization and adjuvant photocoagulation of the peripheral retina to the pars plana. This technique treats the etiology of the problem, improves final best-corrected visual acuity, and, most importantly, helps prevent recurrent bleeding.

Treatment of retinal detachment secondary to macular hole in high myopia: vitrectomy with dissection of the inner limiting membrane to the edge of the staphyloma and long-term tamponade.

PURPOSE: To evaluate the rates of retinal reattachment and the closure of myopic macular hole because of posterior pole retinal detachment after treatment with pars plana vitrectomy and subsequent dissection of the inner limiting membrane. METHODS: Prospective noncomparative study of 27 eyes from 27 phakic patients diagnosed with posterior pole retinal detachment as a result of myopic macular hole. All underwent pars plana vitrectomy with dissection of the inner limiting membrane and intravitreal silicone oil tamponade performed by the same surgeon. The main variables assessed were visual acuity, retinal reattachment, and macular hole closure determined by optical coherence tomography. RESULTS: Of the 27 eyes, 16 (59.3%) were right eyes and 11 (40.7%) were left eyes. Mean age was 50.5 years. Myopia ranged from -9 diopters (D) to -27 diopters (mean, -18 diopters), and axial length ranged from 28.5 mm to 35.6 mm (mean, 32.05 mm). After a mean postoperative period of 12 months, retinal reattachment was found in 85.1% of the patients and anatomical closure of the macular hole in 51.9%. CONCLUSION: This technique offers good rates of retinal reattachment and macular hole closure, although seldom increases the final visual acuity. It showed limited effectiveness in eyes with an axial length >30 mm.

Surgical mobilization of an arterial embolus in cilioretinal artery occlusion.

We describe an effective surgical approach for the management of cilioretinal artery occlusion. A 23-G pars plana vitrectomy assisted with two soft tip cannulas was performed. One cannula pressed the cilioretinal artery branch directed toward the macula, distal to the location of the embolus, whereas the other cannula was used to gently swipe over the cilioretinal artery proximal to the occlusion. Anatomical and functional outcomes were evaluated by fundus examination, fluorescein angiography, Goldmann visual field, and best-corrected visual acuity (BCVA). It was possible to mobilize the embolus by mechanical displacement with 23-G soft-tip cannulas and disintegrate it, preventing the passage toward the branch directed to the macula. Restoration of retinal circulation was confirmed by fluorescein angiogram. The patient recovered his previous documented BCVA and visual field. The described technique can be considered as a new possibility for achieving a solution to cilioretinal artery occlusion or any other retinal artery occlusion.

Globe penetration during loco-regional anesthesia: prevalence and review of cases.

AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment (CD). The initial surgical approach was performed within the first 48h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD. CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after loco-regional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.

Diabetic Retinopathy Is Associated with Decreased Tyrosine Nitrosylation of Vitreous Interleukins IL-1α, IL-1ß, and IL-7.

OBJECTIVE: To simultaneously evaluate tyrosine nitrosylation and phosphorylation levels of vitreous interleukins of patients with diabetic retinopathy, in which abnormal tyrosine phosphorylation has been previously described. RESEARCH DESIGN AND METHODS: Specific immunoprecipitation of interleukins IL-1α, IL-1ß, IL-2 and IL-7 was carried out in samples obtained during vitrectomy performed for proliferative diabetic retinopathy in patients (n=12) and for macular hole in controls (n=12). Tyrosine nitrosylation and phosphorylation levels of the immunoprecipitated interleukins were analysed by Western blot with the respective specific antibodies and correlated. The results were also correlated with the total amount of immunoprecipitated interleukin protein. The mean phosphorylation/nitrosylation ratios of these proteins in vitreous humour of both the control group and diabetic patients were determined. RESULTS: Diabetes was associated with decreased tyrosine nitrosylation of IL-1α, IL-1ß and IL-7 and an increased tyrosine phosphorylation/nitrosylation ratio with respect to controls in IL-1α (1.58±0.22 vs. 2.74±0.39, respectively; p<0.05) and IL-7 (2.15±0.01 vs. 3.26±0.57, respectively; p<0.05). No significant changes were observed in nitrotyrosine or in the tyrosine phosphorylation/nitrosylation ratio of IL-2. CONCLUSIONS: Proliferative diabetic retinopathy is associated with concomitant and simultaneous changes in both tyrosine phosphorylation and tyrosine nitrosylation status of specific pro-inflammatory interleukins present in the vitreous fluid such as IL-1α, IL-1ß and IL-7. These changes could be related to the increase in pro-inflammatory activity detected in diabetes-induced retinopathy.

Internal limiting membrane graft as a treatment for the retinal detachment secondary to an optic disc coloboma.

PURPOSE: To report our anatomical outcome with the internal limiting membrane (ILM) graft procedure in the management of rhegmatogenous retinal detachment (RRD) secondary to optic disc coloboma (ODC). METHODS: Description of a new surgical procedure in one eye of one patient who underwent pars plana vitrectomy (PPV) combined with ILM graft technique. Subsequent follow-up included optical coherence tomography (OCT) and visual acuity. RESULTS: After only 1 week, the OCT revealed the ILM graft plugging the retinal tear with complete resorption of subretinal fluid. The sealing effect of this graft persisted after 6 months. However, visual outcome was poor and corrected distance visual acuity was 20/200 as a result of the previous long-standing retinal detachment with loss of photoreceptors. CONCLUSION: We suggest that ILM graft could be performed as a first line treatment in the management of RRD secondary to ODC. This direct closure of the retinal tears, allows a quick and effective interruption of the communication between the subretinal space and the vitreous cavity. Detecting these retinal tears and applying this technique as soon as possible could achieve not only an earlier anatomical success but obtain good visual results in retinal tears with RRD secondary to ODC. Further studies will be necessary to provide more evidences.

New applanation tonometer for myopic patients after laser refractive surgery.

This study assesses the agreement between intraocular pressure (IOP) measurements taken with the Goldmann applanation tonometer (GAT) and a new experimental applanation tonometer with a convexly shaped apex (CT) after laser myopic refractive surgery. Two different CT radii (CT1 and CT2) were designed with a finite element analyser, and a prospective double masked study on 102 eyes from 102 patients was carried out. A Bland-Altman plot and intra-class correlation coefficient (ICC) were calculated to assess the agreement between GAT measurements and the measurements of both CT1 and CT2 before and after myopic laser assisted in situ keratomileusis (LASIK; n = 73) and photorefractive keratectomy (PRK; n = 29). We evaluated a subset of two subgroups (n = 36 each) for intra and inter-observer (IA/IE) error. From the whole cohort, the best IOP agreement was observed between GATpre and CT1post surgery: 16.09 ± 2.92 vs 16.42 ± 2.87 (p < 0.001); ICC = 0.675 (95% CI: 0.554-0.768). In the analysis of LASIK vs PRK, GATpre and CT1post showed the highest agreement, although LASIK measurements were more accurate than PRK, as the ICC = 0.718 (95% CI: 0.594-0.812) and ICC = 0.578 (95% CI: 0.182-0.795) respectively. Excellent agreement was observed for IA/IE, and there was an ICC > 0.8 (95% CI) in all cases. CT1 proved more accurate in the LASIK subgroup. In conclusion, our new version of GAT could be used with post-surgery LASIK patients as a more accurate measurement device compared to the current reference tonometer.

Long-term outcome of scleral-sutured posterior chamber intraocular lens: a case series.

PURPOSE: Purpose: To evaluate the long-term stability of scleral-sutured intraocular lenses (IOLs) and analyse the possible causes of suture breakage. SETTING: Barraquer Institute in Barcelona, Spain. DESIGN: Retrospective study of consecutive cases. METHODS: Study of patients with scleral-sutured IOL with aphakia, subluxated or luxated IOL were included. Follow-up was longer than 6 months and patients over 18 years of age. Preoperative data (best-corrected visual acuity testing (BCVA), intraocular pressure (IOP), axial length and slit-lamp examination), intraoperative data (characteristics of the scleral flaps, suture material (Prolene or Mersilene) and scleral-sutured IOL) and postoperative data (BCVA, IOP, slit-lamp examination and complications) through 10 years were collected for analysis. RESULTS: 345 consecutive cases of scleral-sutured IOL were included. 25 eyes underwent a second operation after a prior sutured IOL due to suture breakage (mean 40.2±39.6 months after the first surgery) and three of them needed a third surgery. Younger adults (less than 40-year old), the use of a combination of Prolene and Mersilene sutures to perform the surgery and suturing only one flap were found to have higher risk of suture breakage after a follow-up of 10 years. The probability of surviving of the scleral-sutured IOL at 10 years after surgery was 0.79. CONCLUSIONS: Scleral-sutured posterior chamber IOL in eyes with a lack of capsular support is a safe and effective procedure with a low rate of complication and stable visual acuity. Further studies with special focus on young adults or myopic eyes are required to demonstrate long-term safety in those special cases.

A RESCUE THERAPY FOR PERSISTENT OPTIC DISK PIT MACULOPATHY IN PREVIOUSLY VITRECTOMIZED EYES.

PURPOSE: To report the results of vitrectomy with platelet-rich plasma (PRP) application and gas tamponade as a rescue therapy in previously vitrectomized eyes with optic disk pit (ODP) maculopathy. METHODS: Three patients with visual loss due to persistent or recurrent ODP maculopathy who had undergone previous vitrectomy were offered application of PRP. Platelet-rich plasma was obtained by centrifugation of a blood sample from each patient. Surgery consisted of vitrectomy and internal limiting membrane peeling if the membrane had not been already removed (in two eyes). After fluid/air exchange, three drops of PRP were applied on the ODP followed by 8% C3F8 tamponade. Immediately after surgery, the patient remained supine for 30 minutes and then kept a face-down position for 2 weeks. RESULTS: Optic disk pit maculopathy improved as soon as two weeks after surgery and resolved in all eyes between six and eight months after PRP application. Patients were followed up for three years, with no recurrences. Visual acuity remained stable in one eye and improved in two eyes. CONCLUSION: Vitrectomy with PRP application may be useful as a rescue therapy in patients with refractory ODP maculopathy. Platelet-rich plasma may act by promoting the closure of the communication between the vitreous and the intraretinal/subretinal space at the pit. This treatment may avoid potentially harmful maneuvers that have been used to treat ODP maculopathy.

Internal limiting membrane translocation for refractory macular holes.

BACKGROUND/AIMS: Closure is more difficult to achieve in macular holes that remain open following a previous unsuccessful pars plana vitrectomy (PPV). We present our results with the internal limiting membrane (ILM) translocation technique that is used to optimise outcomes in refractory macular holes. METHODS: A prospective, interventional, case series was conducted. 12 eyes of 12 consecutive patients with incomplete sealing of the macular hole (open and type 2 closure) after a previous PPV with ILM peeling were included. Measured baseline parameters included best-corrected visual acuity (BCVA) and macular hole smallest diameter, base diameter and height. Surgeries were performed by harvesting a fragment of the ILM near the vascular arcades and subsequently placing it inside the hole. Postoperative measured outcomes included macular hole status, foveal contour, outer retina integrity, BCVA and surgery-related complications. RESULTS: Anatomic closure occurred in 11 of 12 eyes (91%). This technique elicited a statistically significant improvement in BCVA (p=0.008). Mean BCVA was 20/400 at study baseline and 20/160 at final follow-up. However, less than 16.7% of cases had a final BCVA of ≥20/63. CONCLUSION: The ILM translocation technique seems to facilitate persistent idiopathic macular hole closure, where primary surgery with PPV and ILM peeling failed.