A patient was referred to me for a second opinion. She previously had bilateral vitrectomy and gas for full thickness macular holes (MHs) at an outside surgical center, but the MHs did not close after surgery. The patient was unable to visit the clinic for preoperative examinations, and instead underwent surgery the day of her presentation.
Early during surgery, I opted to use adjuvant stain in order to evaluate for residual membranes (Figure 1). Indeed, epiretinal membrane (ERM) was revealed and removed, which was followed by a complete peel of residual internal limiting membrane (ILM), evaluation of the peripheral retina, and air-fluid exchange.
Given the patient’s prior experience of non-closure of the MH, I decided to use a small drop of autologous blood to act as a scaffold in the MH to encourage closure. I asked the anesthesiologist to draw up a small amount of the patient’s blood sterilely, and a small drop of blood was placed into the MH with a 27-gauge extrusion under air (Figure 2).
Figure 2. Application of autologous blood proved effective at promoting closure of a recalcitrant MH.
At 6 weeks’ postoperative follow-up, the MH had closed and BCVA improved to 20/50. The patient’s contralateral eye has not yet been operated on.
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