Drs. Russel Dinh and Avni Finn describe the case of a 70-year-old female with pseudophakia who was referred for persistent macular hole despite two previous vitrectomies with internal limiting membrane (ILM) peeling. After creating an ILM free flap to place inside of the macular hole to act as a scaffold for hole closure, a 41-gauge subretinal cannula was used to inject BSS in the subretinal space to mobilize the retina. Five blebs were created, targeted two thirds of the distance from the fovea to the vascular arcades, and a finesse loop was used to gently massage the hole edges to further mobilize the retina, followed by fluid–air exchange. At one- and three-month postoperative appointments, the hole had closed and visual acuity had improved to 20/150.

Financial Disclosures: Dr. Russel Dinh discloses no financial relationships. Dr. Avni Finn discloses financial relationships with Abbvie, Apellis, Iveric Bio, Eyepoint, Genentech (Consultant/Advisor).