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to report a case of macular hole closure after the exchange of a silicone - oil tamponade with gas c3f8 14% .
a 64-year - old female patient with a stage iv macular hole underwent a three - port pars - plana vitrectomy and internal limiting membrane peeling . due to the patient 's chronic illness ( respiratory problems ) , a silicone - oil tamponade was preferred .
macular hole closure was confirmed with optical coherence tomography six weeks after exchanging the silicone oil with gas .
macular hole surgery using a silicone - oil tamponade has been proposed as treatment of choice for patients unable to posture . in our case , the use of a long - acting gas ( c3f8 14% ) , even without posturing , proved to be more effective .
idiopathic macular hole is a common cause of visual impairment in people in their sixth decade or older , with a higher prevalence in females .
pars - plana vitrectomy was introduced as treatment of choice for a full thickness macula hole ( ftmh ) in the early 1990s . since then , a number of modifications in the surgical technique have been introduced in order to achieve anatomical restoration of the macular area . internal limiting membrane ( ilm ) peeling   and
the use of substances such as autologous platelets and/or serum have been proposed as adjuncts to the standard procedure to achieve a higher success rate .
the use of a gas tamponade and face - down position postoperatively were considered mandatory for optimal results .
we report a case of a ftmh ( stage iv ) , which was initially treated with pars - plana vitrectomy , ilm peeling and a silicone - oil tamponade .
anatomical closure was achieved only when the silicone oil was replaced by long - acting gas c3f8 ( 14% ) , four months after the first surgery .
a 64-year - old female patient was referred to our clinic with complaints of a gradual deterioration of vision in her left eye over the last six months . on initial examination ,
snellen visual acuity was 0.9 in her right eye and 0.1 in her left eye .
dilated fundus examination showed a normal fundus in her right eye , but revealed a macular hole in her left eye .
optical coherence tomography ( oct ) confirmed the presence of a stage iv macular hole ( fig .
1 ) . the patient had undergone an uneventful cataract surgery with intraocular lens implantation in both eyes the previous year .
the patient underwent a standard vitrectomy procedure followed by air - fluid exchange and ilm peeling using membrane blue .
silicone oil ( 1,000 centistokes ) was used as the optimal tamponade instead of a long - acting gas , as postoperative posturing was not possible for the patient due to her respiratory problems .
four months later , the visual acuity in her left eye was still 0.1 , and oct imaging showed that the macular hole was still flat open ( fig .
the patient underwent a second surgical procedure where the silicone oil was exchanged with a long - acting gas , c3f8 ( 14% ) , without any further intervention or posturing .
macular hole closure was confirmed by oct six weeks later and has remained stable since then ( fig .
following successful pars - plana vitrectomy for ftmh , glial and mller cells form a plug within the hole and this allows the edges to close .
the presence of residual fluid in the hole postoperatively may split the plug formation and inhibit the approximation of the hole edges .
the use of a tamponade provides a floatation force that maintains the macula dry and keeps the edges in close proximity .
long - acting gas remains the tamponade of choice , providing sufficient floatation force , which is greater in a face - down position .
furthermore , in comparison to the use of silicone oil , which needs removal in a second surgical intervention , a subsequent procedure is not required .
however , silicone oil is still an alternative option for patients with specific health problems ( e.g. in patients who are not able to posture ) and in patients with a single eye who require rapid rehabilitation .
silicone - oil tamponade has also been proposed for the management of large or re - opened macular holes .
it has been reported that prolonged macular tamponade with long - acting gas and a strict face - down position has a high closure rate , even in holes larger than 400 m [ 4 , 6 ] . on the contrary , tornambe et al .   described good anatomical results with the use of long - acting gas regardless of the head position .
the use of silicone oil in ftmh surgery has been shown to be effective , with a high anatomical success rate but contradictory functional outcome [ 5 , 8 , 9 ] . in our case ,
not only silicone - oil tamponade did not lead to anatomical restoration but the macular hole healed without posturing with the use of long - acting gas c3f8 ( 14% ) .
purposeto report a case of macular hole closure after the exchange of a silicone - oil tamponade with gas c3f8 14%.methoda 64-year - old female patient with a stage iv macular hole underwent a three - port pars - plana vitrectomy and internal limiting membrane peeling . due to the patient 's chronic illness ( respiratory problems ) , 
 a silicone - oil tamponade was preferred . 
 however , the macula hole was still flat opened four months postoperatively . therefore , the patient underwent an exchange of silicone oil with gas c3f8 14% . 
 no face - down position was advised postoperatively due to her health problems.resultsmacular hole closure was confirmed with optical coherence tomography six weeks after exchanging the silicone oil with gas.conclusionsmacular hole surgery using a silicone - oil tamponade has been proposed as treatment of choice for patients unable to posture . in our case , 
 the use of a long - acting gas ( c3f8 14% ) , even without posturing , proved to be more effective .