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MACULAR HOLE HYDRODISSECTION: 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: PDF Only

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: efrem.mandelcorn@utoronto.ca

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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.retinajournal.com).

© 2018 by Ophthalmic Communications Society, Inc.