This study aims to evaluate the efficacy, safety, and immunogenicity of ZRC-3285 (aflibercept biosimilar) with Eylea® (aflibercept) in patients with neovascular (wet) age-related macular degeneration (nAMD). This phase III, multicenter, double-blind study was conducted across 27 sites in India and randomized (2:1) patients with nAMD into either the test aflibercept (ZRC-3285, Zydus Lifesciences Ltd.) or Eylea® (Regeneron Pharmaceuticals, Inc.) groups. All 184 enrolled patients (122 and 62 in the ZRC-3285 and Eylea® groups, respectively) were included in the modified intend-to-treat (mITT) population. ZRC-3285 or Eylea® was administered by intravitreal injection at a dose of 2 mg (0.05 mL) on days 1, 29, and 57. The primary objective was to assess non-inferiority of ZRC-3285 versus Eylea® in treating nAMD and was evaluated by determining the proportion of patients who lose fewer than 15 letters from baseline visual acuity over 12 weeks using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Secondary objectives included comparison of additional efficacy outcomes, immunogenicity, and safety. Over 12 weeks, all patients in the ZRC-3285 (122, 100

PURPOSE:To assess anatomical and functional outcomes of encircling or segmental buckle in premature infants with stage 4 retinopathy of prematurity (ROP). METHODS:This retrospective, single-center, interventional study included preterm infants with stage 4A or 4B ROP who underwent encircling (Group A) or segmental (Group B) scleral buckle. Surgical outcomes, long-term sequelae, and comorbidities were evaluated. RESULTS:A total of 105 eyes (90 infants) were analyzed-85 in Group A and 20 in Group B. Stage 4A was present in 75 eyes. The mean gestational age was 30.05 ± 2.73 weeks; mean birth weight, 1383 ± 411.01 gram. Primary surgical success was 90.5% in Group A (4A: 93.9%; 4B: 78.9%) and 90% in Group B (4A: 88.8%;4B: 90.9%). Preoperative treatment and combined intraoperative interventions significantly improved anatomical success ( P < 0.05). Mean spherical equivalent was -6.00 D in Group A and -3.12 D in Group B. Functional vision (central, steady, maintained) was achieved in 32% of Group A and 55% of Group B. Common sequelae included disc drag and macular ectopia; comorbidities included myopia, strabismus, and nystagmus. CONCLUSION:Scleral buckling is an effective and less invasive treatment for selected cases of stage 4 ROP with peripheral traction.

PURPOSE:To evaluate the demographic and clinical characteristics, treatment indications, long-term outcomes and prognostic factors in patients with congenital x-linked retinoschisis (CXLR) managed conservatively or surgically. METHODS:This retrospective, international, multicentre study included data from retina specialists across 14 centres in 9 countries. Demographic information, best corrected visual acuity (BCVA), phenotype, optical coherence tomography (OCT) findings and disease management were analysed. Surgical indications, techniques and anatomical and visual outcomes were evaluated. RESULTS:A total of 635 eyes of 318 patients were included. Median age at presentation was 9 years (range: 0-81). Observation was preferred in 73.5% of eyes, laser photocoagulation (LPC) in 9.3% and vitreoretinal surgery in 18.1%. Surgical patients presented younger (7 vs. 10 years; p = 0.002) and with worse baseline BCVA (1.50 vs. 0.50 LogMAR; p < 0.0001). Disease symmetry was lower in surgical cases (24.4%) than in conservative and LPC groups (p < 0.0001). Vitreous veils, peripheral pigmentary changes and white spiculations were predictive of surgical need, particularly in eyes with rhegmatogenous retinal detachment (RRD) and vitreous haemorrhage (VH). OCT predictors of peripheral progression included absence of ganglion cell layer cysts and presence of outer plexiform layer cysts. Single-surgery anatomical success was 68.7%, increasing to 94.7% with additional procedures. Inner-wall retinectomy significantly improved outcomes in macula-threatening retinoschisis (p = 0.026). Visual acuity improved significantly after surgery in RRD and VH cases (p = 0.003). CONCLUSION:CXLR shows a broad clinical spectrum requiring individualized care. Fundus and OCT features effectively predicted progression and surgical need. Surgical management achieved high success, with inner-wall retinectomy beneficial in certain cases.

The management of proliferative diabetic retinopathy (PDR) presents both established consensus and ongoing controversies, particularly regarding emerging therapies (anti-vascular endothelial growth factor agents [VEGF], subthreshold laser and intravitreal steroids) versus conventional approaches (laser photocoagulation and vitrectomy). The Asia-Pacific Vitreo-retina Society (APVRS), the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) and the Academia Retina Internationalis (ARI) saw such a need to establish consensus and controversial statements on PDR management. They formed an international panel of experts (IPE) comprising 26 experts from 13 countries/territories to establish the statements, including diagnosis and diagnostic technologies, screening approaches, laser, anti-VEGF, intravitreal steroids and vitrectomy and related techniques in PDR management. The objective is to synthesize evidence-based real-world practice recommendations from leading global experts to guide the management of PDR. Of the 37 statements, the IPE reached consensus (75% voted as “Strong Agreement” or “Agreement”) on 28 (76%) statements. Controversial statements, such as panretinal photocoagulation (PRP) in special scenarios, use of steroids in cases unresponsive to anti-VEGF and PRP and during vitrectomy to improve visual oucomes, and specific surgical techniques such as internal limiting membrane peeling and drainage retinotomy in the treatment of PDR are identified. Given its high prevalence and propensity for visual morbidity, and the recent advances in surgery for PDR, confirming the standard practices and deliberating on controversies to find the best approach by international experts would help improve the management of PDR further.

Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of vision loss globally. This is a comprehensive review focused on both medical and surgical management strategies for DR and DME. This review highlights the epidemiology of DR and DME, with a particular emphasis on the Asia-Pacific region, urban-rural disparities, ethnic variations, and grading methodologies. We examine various risk factors for DR, including glycemic control, hypertension, hyperlipidemia, obesity, chronic kidney disease, sex, myopia, pregnancy, and cataract surgery. Furthermore, we explore potential biomarkers in serum, proteomics, metabolomics, vitreous, microRNA, and genetics that may aid in the detection and management of DR. In addition to medical management, we review the evidence supporting systemic and ocular treatments for DR/DME, including anti-vascular endothelial growth factor (anti-VEGF) agents, anti-inflammatory agents, biosimilars, and integrin inhibitors. Despite advancements in treatment options such as pan-retinal photocoagulation and anti-VEGF agents, a subset of cases still progresses, necessitating vitrectomy. Challenging diabetic vitrectomies pose difficulties due to complex fibrovascular proliferations, incomplete posterior vitreous detachment, and fragile, ischemic retinas, making membrane dissection risky and potentially damaging to the retina. In this review, we address the question of challenging diabetic vitrectomies, providing insights and strategies to minimize complications. Additionally, we briefly explore newer modalities such as 3-dimensional vitrectomy and intra-operative optical coherence tomography as potential tools in diabetic vitrectomy. In conclusion, this review provides a comprehensive overview of both medical and surgical management options for DR and DME. It underscores the importance of a multidisciplinary approach, tailored to the needs of each patient, to optimize visual outcomes and improve the quality of life for those affected by these sight-threatening conditions.

BACKGROUND:Surgery for stages 4 and 5 of retinopathy of prematurity (ROP) is challenging. The long-term results even in initially successful cases are not satisfactory. Data on long-term results are sparse. METHODS:Retrospective analysis of patients with stages 4 and 5 of ROP who underwent surgery at a tertiary care center and had a minimum follow-up of 5 years. Most stage 4 a and 4b were managed by scleral buckling or lens sparing vitrectomy, while most stage 5 needed lens sacrificing vitrectomy. The anatomical success was assessed at 6 weeks postsurgery and again at the last follow-up, while the visual success was assessed only at final follow-up visit. RESULTS:84 eyes of 60 patients with a mean follow-up of 9.27 years were analyzed. The mean age at presentation was more in stage 5 ROP compared to stage 4a and 4b (P < 0.001). Overall anatomical success was seen in 94.2% of stage 4a, 82.35% of stage 4b, and 63.6% of stage 5 at 6 weeks, which deteriorated to 88.2% in stage 4a, 70.59% in stage 4b, and 30.3% in stage 5 at the end of last follow-up. At last visit, the highest level of corrected vision attained was 6/9 in stage 4a, 6/18 in stage 4b, and 6/60 in stage 5 ROP. CONCLUSIONS:Anatomical and visual results are better with stages 4a and 4b compared to stage 5 ROP. On long-term follow-up, the incidence of recurrent retinal detachment is highest in stage 5 ROP.

This case series describes the clinical features and genetic testing results of four patients from two families affected by Knobloch syndrome (KS). KS is an autosomal recessive collagenopathy characterized by vitreoretinal degeneration, high myopia, retinal detachment, and occipital encephalocele. In addition, a myriad of other ophthalmic and systemic features may be present in the affected individuals. Mutations in the COL18A1 gene are primarily implicated in the pathogenesis of the disease. The phenotypical differences seen in our genetically-proven patients show the clinical heterogeneity of this condition. Diagnosis of KS type-1 was confirmed by genetic analysis in all affected patients. Surgical intervention was done to salvage vision in three patients. This case series highlights the importance of meticulous clinical examination and diagnosis of this rare condition. Genetic counseling and testing are important for suspected patients and for guiding patients on the visual prognosis of the disease.

Purpose: To report the long-term anatomical and functional results of lens-sparing vitrectomy (LSV) for stage 4 retinopathy of prematurity (ROP). Design: Retrospective study. Methods: This is a study of 23 eyes of 16 patients with stage 4 ROP who underwent lens-sparing vitrectomy at a tertiary care center and had a minimum of 2 years of follow-up. The main outcome measures are the retinal status and visual outcome at the final follow-up. Results: After a mean follow-up of 7.36 years, the lenses remained clear in 69.57%; anatomical success in terms of the attached retina was achieved in 19/23 eyes (82.61%) and vision of ≥6/24 was achieved in 8/23 eyes (34.78%), whereas navigational vision (≥1/60) was achieved in 16/23 (69.56%). The mean spherical equivalent was −8.50 + 6.39 diopters. High myopia (≥7 dsph) was noted in 43.47% of patients. The severity of myopia was not related to previous lasers and was less severe in eyes with posterior pole residual folds compared to normalized fundus or eyes with macular drag but no fold. At the final follow-up, 3/16 (18.75%) patients had bilateral blindness due to total retinal detachments and 11/16 (68.75%) had recorded functional vision in one or both eyes, whereas two others could potentially be having vision but could not be evaluated. Conclusions: The long-term results of lens-sparing vitrectomy for stage 4 ROP are favorable with a majority retaining clear lenses and attached retina and two-thirds having functional vision.

Background: A 7-year-old male child was brought by his parents with a complaint of low vision in both eyes for 2 months. The child had low vision in both the eyes for 1.5 years, but the parents noticed when it worsened further 2 months back, leading to profound vision loss. On ophthalmic evaluation, the child did not perceive light in the right eye. Furthermore, anterior segment examination showed complicated cataract and open funnel retinal detachment with intra-retinal cysts in ultrasound (USG) B scan. In the left eye, he could appreciate light but with poor fixation. Fundus evaluation of the left eye showed total retinal detachment on indirect ophthalmoscopy, which was confirmed on USG B scan. Since the right eye had poor visual potential, no intervention was done. The left eye underwent pars plana vitrectomy with silicone oil tamponade, which led to successful anatomical outcomes. The immediate and late postoperative periods were uneventful, and the child was kept under follow-up and was observed closely. Purpose: To educate regarding the surgical management of giant retinal tears in a pediatric patient. Synopsis: To inform regarding the surgical challenges faced and steps adopted to manage such cases. Highlights: Through this case, we want to highlight the challenges faced, such as delayed presentation, difficult preoperative evaluation, intraoperative difficulties such as mobile retina, absence of posterior vitreous detachment, and tenacious vitreous gel. We also want to emphasize on the steps taken to overcome the challenges. Conclusion: In such challenging situations, effective planning, careful manipulation, and persistence are essential for success. Video Link: https://youtu.be/T0Gy6Wj13zI

PURPOSE:The management of idiopathic macular holes (iMH) has evolved over time with various modifications in surgical approach. The study aimed to survey the surgeons' preferences in the management of iMH in current times. DESIGN:Cross-sectional descriptive survey. METHODS:A 12-item questionnaire addressing the key aspects of iMH management was sent, between October 2022 to November 2022, by personal correspondence to 104 vitreoretinal specialists, actively practicing and performing iMH surgeries at various institutes in India. The responses were gathered till January 2023 and analyzed as per appropriate statistical methods. RESULTS:Ninety-one retina specialists responded to the survey (response rate of 87.5%) with a median annual surgical load of 30 cases (range: 5-150). Most respondents had similar views on patient selection, combined phaco-vitrectomy, internal limiting membrane (ILM) staining, ILM peel initiation and propagation, tamponade, postoperative positioning, and prognostic factors. The preferred approach for peel initiation was "pinch and peel," but "scrape and peel" was equally recommended for beginners. Most respondents considered iMH >600 microns in size as large and used additional surgical maneuvers for large and failed cases such as ILM flap, large flap, macular detachment, platelet-rich plasma application, and amniotic membrane graft. The three most important visual prognostic factors were duration, preoperative vision, and MH size. CONCLUSIONS:The practice of surveyed surgeons performing iMH surgery was uniform in several aspects. There is a need to create consensus on the preferred ILM peel technique among trainee surgeons, revisit the iMH size classification, and standardize the surgical approach as per hole size and characteristics.

Introduction:Aggressive retinopathy of prematurity (AROP) is a severe and progressive variant of retinopathy of prematurity (ROP) rapidly forming fibrous tissue extending from the disc toward the posterior lens surface progressing to Stage 5 disease without traversing the classical course that includes Stages 1 to 3. Since AROP behaves differently from type 1 ROP, this study was undertaken to evaluate the surgical outcome of AROP-related detachments. Methods:Retrospective analysis of data from electronic medical records of babies diagnosed with AROP-related detachments who underwent micro-incision vitrectomy surgery (MIVS) was included. The demographic data, details of primary intervention (laser and/or intravitreal bevacizumab), and surgery were noted. In a subset of patients, surgical intervention was planned early at the onset of fibrovascular tissue. Results:43 eyes of 26 babies with median birth weight 1175 g and median gestational age of 29 weeks were analyzed. 42/43 eyes underwent primary intervention in form of laser and/or anti-VEGF injection before surgery. 41.8%, 25.5%, and 32.5% eyes progressed to stages 4A, 4B, and 5, respectively, requiring surgical intervention. 66% eyes underwent lensectomy and vitrectomy (LV), and 44% eyes underwent lens sparring vitrectomy (LSV). 58% eyes had attached macula. 44% eyes that had a relatively less vascular diseases had better anatomical outcome (P = 0.019). At final follow-up, 53.4% eyes followed or at least had light fixation, and 77.7% eyes undergoing LSV fixated and/or followed light compared to 33% for LV (P = 0.04). Conclusion:Challenges in AROP include rapid progression to advanced stages of ROP requiring close monitoring and multiple interventions. Surgeries for AROP have a favorable anatomical and functional outcome in 58% and 53%, respectively. Eyes undergoing lens sparing vitrectomy had better visual outcomes.

Purpose: To study the presentation and outcomes of infantile Terson syndrome (TS). Methods: This was a retrospective analysis of 18 eyes of nine infants diagnosed to have TS-related intraocular hemorrhage (IOH). Results: Nine infants (seven males) were diagnosed to have IOH secondary to TS, of which eight infants had imaging features suggestive of intracranial bleed meeting our definite criteria. Median age at presentation was 5 months. In 11 eyes of six infants with suspected birth trauma, the median age of presentation was 4.5 months (range 1–5 months) of which one baby had a history of suction cup-aided delivery and four babies had a history of seizures. Vitreous hemorrhage (VH) was noted in 15 eyes (extensive in 11 eyes). Ten of these eyes showed membranous vitreous echoes, or triangular hyperechoic space with apex at the optic nerve head (ONH) posteriorly and base at the posterior lens capsule anteriorly, with or without dot echoes in the rest of the vitreous cavity, with a configuration of “tornado-like hemorrhage” suggestive of Cloquet's canal hemorrhage (CCH). Eight eyes underwent lens-sparing vitrectomy (LSV) and one eye underwent lensectomy with vitrectomy (LV). On follow-up, disc pallor and retinal atrophy were noted in 11 and 10 eyes, respectively. The mean follow-up was 62 months (1.5 month–16 years). Visual acuity/behavior improved in all cases at the final follow-up. Developmental delay was noted in four children. Conclusion: Unexplained and altered vitreous hemorrhage with typical ultrasonography (USG) features should raise the suspicion of CCH in TS. Despite early intervention to clear visual axis, anatomical and visual behavior may remain subnormal.

Purpose: Inherited retinal dystrophies (IRD) are a heterogeneous group of retinal diseases leading to progressive loss of photoreceptors through apoptosis. Retinitis pigmentosa (RP) is considered the most common form of IRD. Panel-based testing in RP has proven effective in identifying the causative genetic mutations in 70% and 80% of the patients. This is a retrospective, observational, single-center study of 107 RP patients who had undergone next-generation sequencing-based targeted gene panel testing for IRD genes. These patients were inspected for common phenotypic features to arrive at meaningful genotype–phenotype correlation. Methods: Patients underwent complete ophthalmic examination, and blood was collected from the proband for DNA extraction after documenting the pedigree. Targeted Next Generation Sequencing (NGS) was done by panel-based testing for IRD genes followed by co-segregation analysis wherever applicable. Results: Of the 107 patients, 72 patients had pathogenic mutations. The mean age of onset of symptoms was 14 ± 12 years (range: 5–55). Mean (Best Corrected Visual Acuity) BCVA was 6/48 (0.9 logMAR) (range 0.0–3.0). At presentation, over one-third of eyes had BCVA worse than 6/60 (<1 logMAR). Phenotype analysis with the gene defects showed overlapping features, such as peripheral well-defined chorioretinal atrophic patches in patients with CERKL , PROM1 , and RPE65 gene mutations and large macular lesions in patients with RDH12 and CRX gene mutations, respectively. Nummular or clump-like pigmentation was noted in CRB1 , TTC8 , PDE6A , and PDE6B . Conclusion: NGS-based genetic testing can help clinicians to diagnose RP more accurately, and phenotypic correlations can also help in better patient counselling with respect to prognosis and guidance regarding ongoing newer gene-based therapies.

Retinopathy of prematurity (ROP) is the leading cause of preventable infant blindness in the world and predominantly affects babies who are born low birth weight and premature. India has the largest number of surviving preterm births born annually. ROP blindness can be largely prevented if there is a robust screening program which detects treatment requiring disease in time. ROP treatment must be provided within 48 h of reaching this threshold of treatment making it a relative emergency. During the severe acute respiratory syndrome-coronavirus disease 2019 pandemic in 2020 ROP screening was disrupted throughout the world due to lockdowns and restriction of movement of these infants, their families, specialists and healthcare workers. The Indian ROP Society issued guidelines for ROP screening and treatment in March 2020, which was aimed at preserving the chain-of-care despite the potential limitations and hazards during the (ongoing) pandemic. This preferred practice guideline is summarized in this manuscript.

Purpose: To assess different approaches in the management of aphakia in adults in Indian ophthalmologists via an online survey. Methods: A survey-monkey based online questionnaire was fielded to Indian ophthalmologists in accordance with the CHERRIES guidelines. We recorded participants’ demographics, practice settings, and preferred surgical options including the type of intraocular lens (IOL) preferred when encountering a case of aphakia in adults with and without adequate capsular support. Differences between anterior segment (AS) surgeons and vitreoretinal (VR) surgeons as well as differences between surgeons with more or less than 10 years of surgical experience were evaluated using analytic statistics. Results: Of the 481 surgeons who responded to the survey, 369 (77%) were AS surgeons and the remaining 112 (23%) were VR surgeons and represented all regions of India. When encountering posterior capsular rent during cataract surgery, a three-piece IOL in the ciliary sulcus was the most preferred (n = 275, 57%) when there was adequate capsular support, while a retrofixated iris-claw IOL (n = 91, 19%) was the commonest choice in eyes without adequate capsular support. With associated nucleus drop, 85% of surgeons preferred to refer the patient to a VR surgeon and left the eye aphakic. Multivariable logistic regression showed that VR surgeons were more than six times likely to prefer a scleral fixated intraocular lens (SFIOLs) [odds ratio (OR) = 6.5, 95% confidence interval (CI) = 3.4–12.5, P < 0.001] and surgeons with >10 years of experience were also twice more likely to prefer an SFIOL (OR = 2.4, 95% CI = 1.2–4.9, P = 0.02). Conclusion: The choice of IOL in absence of capsular support in adult eyes differs between AS and VR surgeons and is also influenced by the surgeon’s experience.

Purpose: To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia-associated foveoschisis (FS) and macular detachment with or without macular hole (MH). Methods: A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25–33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35–74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow-up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow-up was 11.2 months. Results: At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full-thickness macular hole-related retinal detachment was present in nine cases. Swept-source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26–33.8 mm) to 26.2 mm (range 24–29.3 mm). The mean best-corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%). Conclusion: Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.

Background: A 40-year-old male presented with a complaint of sudden onset diminution of vision in the left eye for 2 weeks. He was a follow-up case with retinal hemangioblastoma in both eyes. He underwent two sittings of fundus fluorescein angiography-guided trans-pupillary thermotherapy 2 years back. Since then, he was regularly followed up for 2 years with stable vision and stable retinal findings. At present, the best-corrected visual acuity (BCVA) in the right eye is 6/6, and in the left eye, it is counting fingers 2 meters. On fundus examination, he had one active hemangioblastoma in the right eye and total retinal detachment in the left eye with multiple active lesions. The right eye was treated with a single sitting of thermotherapy, and the left eye underwent pars plana vitrectomy and angioma excision, followed by silicone oil tamponade. The immediate and late post-operative periods were uneventful, with successful anatomical and functional outcomes. The left eye BCVA on late follow-up was 6/36, no further treatment was advised, and the patient was kept under follow-up and observed closely. Purpose: To educate regarding the systemic workup, diagnosis, and surgical management of complicated retinal detachment in retinal hemangioblastoma. Synopsis: Systemic workup, diagnosis, and surgical steps in the management of complicated retinal detachment in retinal hemangioblastoma were performed. Highlights: Close follow-up, keen observation, and prompt treatment in the early stages of the disease are indispensable to prevent untoward sequelae of retinal hemangioblastoma. A thorough systemic workup is necessary to diagnose the systemic involvements early. Surgery, if indicated for the retinal hemangioblastoma or its associated sequelae, should be performed diligently and with careful handling of blood vessels and anomalous tissues. Online Video Link: https://youtu.be/CkoqWEnaPB8

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% C2F6, 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% C2F6, or 12% C3F8 in idiopathic macular hole surgery, the advantage of using a shorter acting tamponade translates into earlier recovery and rehabilitation.