Aim To compare the outcomes of non-posturing macular-hole surgery using sulfur hexafluoride (SF₆) gas versus perfluoroethane (C₂F₆) for idiopathic macular hole repair.

Design Interventional, comparative cohort study.

Methods 39 eyes of 38 patients undergoing macular-hole surgery with SF₆ were compared with another consecutive group of 39 eyes (39 patients) in whom C₂F₆ was used. All patients were operated on by a single surgeon and underwent 23G transconjunctival phakovitrectomy with no prone posturing in the postoperative period. The best-corrected Snellen's visual acuity (VA) was converted to the logarithm of minimal angle of resolution (logmar) visual acuity for analysis. Optical coherence tomography documentation of anatomical closure and complications of surgery were recorded.

Results Primary hole closure was achieved in 89.75% in the C₂F₆ group and 87.2% in the SF₆ group. Secondary closure after non-posturing redo surgery with heavy oil (Oxane-HD) was 100% in both groups. The mean preoperative VA in the C₂F₆ group and SF₆ group was 0.81 logMAR and 0.78 respectively. 2 weeks after surgey, SF₆ was completely absorbed in all cases, and the mean VA improved to 0.5 logMAR; however, it remained 1.9 logMAR in the C₂F₆ group. The final mean VA at 6 months was 0.44 (range 0–0.78) and 0.38 (range 0–1) in the C₂F₆ and SF₆ group respectively. There were no instances of pupillary capture in the SF₆ group, whereas there were four in the C₂F₆ group.

Conclusion Macular-hole surgery with SF₆ gas achieves similar results to C₂F₆ and is absorbed faster, allowing quicker visual rehabilitation for the patient.