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Surgical Technique for the Treatment of Persistent, Chronic, and Large Macular Holes

Felfeli, Tina BSc, MD(C)*,†; Mandelcorn, Efrem D. MD, FRCSC*,†

doi: 10.1097/IAE.0000000000002013
Original Study

Purpose: To present a new technique, macular hole hydrodissection, that increases the likelihood of closure for challenging macular holes (MHs) with multiple risk factors.

Methods: A retrospective review of all consecutive eyes with idiopathic Stage 3 and 4 MHs that were either persistent (failed previous vitrectomy surgery), chronic (symptoms of central vision loss of ≥2 years or a clinical diagnosis for ≥1 year), and/or large (aperture diameter of ≥400 μm), having undergone the macular hole hydrodissection surgical technique between January 1, 2014, and May 1, 2017, from an institutional practice setting was conducted. This technique lyses retina-retinal pigment epithelium adhesions by injecting fluid into the MH and allows for successful closure as the mobile edges are then brought closer together.

Results: Thirty-nine eyes of 39 patients with mean MH aperture and base diameters of 549.1 ± 159.47 μm and 941.97 ± 344.14 were included. Complete anatomical closure was achieved in 87.2% (34/39) of MHs. Vision improvement was observed in 94.9% (37/39) and gain of ≥2 lines was achieved in 79.5% (31/39). Of the MHs that achieved anatomical success, 100% (34/34) had a Type 1 closure. The mean postoperative follow-up was 320.33 ± 269.04 days.

Conclusion: The macular hole hydrodissection surgical technique improves anatomical and functional outcomes of persistent, chronic, and/or large MHs.

Macular hole hydrodissection is a new surgical technique that is readily adopted using standard surgical maneuvers and improves outcomes of challenging macular holes with 87% closure rate and significant gain in visual acuity in 79% of eyes postoperatively.

*Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada; and

Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, University of Toronto Health Network, University of Toronto, Toronto, Ontario, Canada.

Reprint requests: Efrem D. Mandelcorn, MD, FRCSC, DBO, Toronto Western Hospital, University Health Network, 6E-432, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada; e-mail:

Presented at the VIT-Buckle Society Annual Meeting, Las Vegas, NV, April 6–8, 2017, and as a paper at the Canadian Ophthalmological Society Annual Meeting, Montreal, QC, Canada, June 16–18, 2017.

The authors have no financial/conflicting interests to disclose.

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© 2019 by Ophthalmic Communications Society, Inc.