Twenty-three eyes with idiopathic macular hole, that failed to close following vitrectomy, were divided into 2 groups: Group 1 (9 eyes) that where operated upon by the author himself, and Group 2 (14 eyes) that were operated by other surgeons and referred to the author because of non-closure. Eyes in Group 1 are known to have undergone posterior hyaloid and ILM peeling. All eyes underwent OCT. The macular hole was found open, enlarged with elevated retracted edges in 14 eyes. There was an associated rhegmatogenous retinal detachment in 4 eyes. All eyes underwent revision of vitrectomy. Membrane blue revealed the presence of intact or remnants of ILM in 6 eyes. The Tano scraper was used to mobilize the retina towards the centre of the macular hole starting at the temporal vascular arcades. This helps to decrease the size of the hole. The rhegmatogenous retinal detachments were caused by horseshoe tears along the posterior border of the vitreous base or related to vitreous incarcerated in the sclerotomy because of left over basal vitreous gel. These eyes underwent excision of the vitreous base, retinal reattachment with PFCL, endolaser to retinal teats and gas tamponade. In all eyes, the macular hole could be closed and the retina attached.


In conclusion, failed closure of idiopathic macular hole may be related to incomplete or non-peeling of the ILM. In these eyes, peeling of the ILM is associated with closure of the hole. In eyes with already peeled ILM, the use of the Tano’s scraper to mobilize the retinal towards the centre of the hole always followed by closure of the hole. Retinal detachment in these eyes was due to breaks at the posterior border of the vitreous base and neglecting shaving of the basal vitreous gel.