We developed new surgical techniques for refractory macular diseases. In the lamellar macular hole, re-injection of the epiretinal proliferative membrane resulted in recovery of macular configuration in most cases. Subretinal low-density tissue plasminogen activator and intravitreal air were effective in moving the submacular hemorrhage associated with polypoidal choroidal vasculopathy. Postoperative anti-vascular endothelial growth factortherapy maintained visual improvement. Autologous implantation of the internal limiting membrane closed the hole in most (>95%) cases of refractory macular holes. In non-responders to anti-vascular endothelial growth factor therapy with diffuse macular edema, subretinal injection of balanced salt solution (BSS) facilitated resolution of macular edema, resulting in final visual improvement.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 122: 171-179, 2018.