Does vitrectomy followed by intraocular gas tamponade offer sufficiently effective treatment of retinal detachment due to holes in the posterior pole?

We report on 17 consecutive cases of retinal detachment due to macular hole surgically treated by one of the authors (S.B.) between the fall of 1982 and 1985. The standard method used was pars plana vitrectomy and intraocular air tamponade. In cases of subsequent reaccumulation of subretinal fluid, the macular hole was cautiously coagulated. With repeated redetachment and as a last resort, silicone oil was injected into the vitreous cavity. After a follow-up period ranging from 5 to 42 months, 13 of the 17 eyes were cured; in 2 aphakic eyes treatment remained unsuccessful; in 2 eyes a small central detachment with some accumulation of subretinal fluid persisted but did not progress. Vitrectomy and gas tamponade alone, without coagulation, constitute the safest and most sparing treatment of this type of retinal detachment. Unfortunately, approximately one half of these cases require subsequent additional photocoagulation because of renewed accumulation of subretinal fluid. In about one fourth of macular hole retinal detachments, however, lasting reattachment is achieved only by silicone oil tamponade following initial vitrectomy and air/gas tamponade.