Gas‑free macular hole closure demo

A macular hole is a small break in the center of the retina, the spot that gives you sharp vision for reading and faces. Most holes that need treatment are repaired with a vitrectomy, a surgery that removes the eye’s gel and relieves traction. (nei.nih.gov) (asrs.org) Standard macular hole surgery usually adds an internal limiting membrane peel, which removes a thin surface layer from the retina, plus a gas bubble that presses on the hole from inside the eye. Retina Today said closure rates for holes under 400 microns now approach 95% to 100% with modern surgery. (retinatoday.com) That gas bubble is the reason many patients get activity restrictions after surgery, and it has traditionally been paired with face-down recovery. The American Academy of Ophthalmology said the need for gas tamponade and the length of postoperative positioning have both been under active debate. (aao.org 1) (aao.org 2) Into that debate, Dr. Satya Prakash Tiwary posted a deferred live surgical demo describing macular hole closure on postoperative day one without gas and without prone positioning. The case was presented with a 27-gauge vitrectomy setup and digital viewing hardware that included Alcon Unity, Zeiss Lumera 700 and Alcon Ngenuity. (drishtipunjeyehospital.com) (x.com) The claim stands out because most published evidence on skipping face-down positioning has still kept a gas bubble in the eye. Mayo Clinic reported a retrospective series of 68 eyes treated with broad internal limiting membrane peeling, 20% sulfur hexafluoride gas and no face-down positioning, with high closure rates. (mayoclinic.org) Published evidence on skipping the gas bubble entirely is newer and thinner. An American Academy of Ophthalmology summary of a 2025 Hong Kong Eye Hospital study said 42 no-gas cases and 51 conventional cases had similar month-three closure rates, 95.2% versus 94.1%, in a retrospective comparison. (aao.org) Earlier case-series evidence was smaller still. A 2021 report in the Journal of VitreoRetinal Diseases described five small macular holes treated with vitrectomy and internal limiting membrane peel alone, with four of five closing without gas; the average narrowest hole size was 227 microns. (pmc.ncbi.nlm.nih.gov) That means Tiwary’s video is best read as a case demonstration, not a practice-changing trial. The American Academy of Ophthalmology’s 2025 review said the no-gas data were retrospective, modest in size and single-center, and called for prospective studies. (aao.org) The technical question is simple even if the surgery is not: can surgeons close selected holes by peeling traction and stabilizing the retina without leaving a gas bubble behind. If larger studies reproduce day-one closure without gas or prone positioning, the biggest change would be in postoperative restrictions and counseling rather than in the core vitrectomy itself. (retinatoday.com) (aao.org)