A prospective, interventional study comparing the outcomes of macular hole surgery in eyes randomized to C₃F₈, C₂F_6, or SF₆ gas tamponade

Purpose: Analysis of outcomes of macular hole (MH) surgery using 12% C₃F₈, 16% C₂F₆, or 18% SF₆ as randomized gas tamponading agent. Methods: This is a prospective, randomized, interventional study of 159 eyes with idiopathic MH undergoing 23/25G pars-plana vitrectomy with internal limiting membrane peeling and gas tamponade. Eyes were stratified into two groups: Group I (MH < 800 µ) and group II (MH > 800 µ) according to MH apical diameter. Eyes in group I were randomized to receive either 18% SF₆, 16% C₂F_6, or 12% C₃F₈. Eyes in group II were randomized to either 16% C₂F₆ or 12% C₃F₈. Clinical details, MH parameters on optical coherence tomography, surgical details and complications were analyzed. Outcome measures were type of hole closure (I/II), best corrected visual acuity, intraocular pressure, and cataract progression. Results: In Group I (n = 139), type 1 closure was achieved in 107 (77%) eyes. Type 1 closure rates in group I per gas tamponade were as follows: SF₆ (70%), C₂F₆ (80%), C₃F₈ (78%) (p = 0.503, chi-square test for independence). There was no statistical difference in MH closure rates between SF₆ and C₂F₆ (p = 0.134), SF₆ and C₃F₈ (p = 0.186), and C₂F₆ and C₃F₈ (p = 0.373). In Group II (n = 20), type 1 closure was achieved in 12 (60%) eyes. Type 1 closure rates in group II per gas tamponade were as follows: C₂F₆ (75%), C₃F₈ (50%) (p = 0.132, Two proportion Z test). Mean follow-up after surgery was 2.66 ± 2.74 months. Conclusion: Given the similar outcomes of using 18% SF₆, 16% C₂F_6, or 12% C₃F₈ in idiopathic macular hole surgery, the advantage of using a shorter acting tamponade translates into earlier recovery and rehabilitation.