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    Plugging the Hole in Double Trouble

    AAO 2023 Video Program
    Peripheral Retina , Retina/Vitreous

    Recurrent retinal detachment (RD) is a challenge; and recurrent RD with a recurrent macular hole after internal limiting membrane (ILM) peeling, an even greater one. In this video, we describe a simple technique to harvest a retinal graft to close the macular hole in a series of three cases. After the necessary procedures to remove the epiretinal membranes and mobilize the retina, the macular area was stained with Brilliant Blue G dye to check for any ILM remnants. A self-retaining endoilluminator was inserted, and a retinal graft approximately double the size of the macular hole was harvested bimanually from the edge of a pre-existing retinal break. The retinal break was anterior to the equator in one case and at the equator in two cases. The graft was mobilized under perfluorocarbon liquid to cover the macular hole. Silicone oil was the tamponading agent in all cases. Visual recovery was good in all cases, and there was no recurrence after silicon oil removal (SOR). Imaging with silicon oil in situ and after SOR showed type 1 closure in all cases and good integration of the graft with the surrounding retinal tissue. Cystoid macular edema was documented in all cases, which responded well to intravitreal dexamethasone implant.