Tapping of Macular Hole Edges: The Outcomes of a Novel Technique for Large Macular Holes.

Abstract

To describe the novel technique of tapping macular hole edges for holes with low macular hole index (MHI) and assess its outcomes. A prospective interventional study. Twenty-eight consecutive eyes with idiopathic large macular holes (MHI < 0.5) were enrolled. A standardized surgical protocol was performed using vitrectomy with brilliant blue G dye-assisted large internal limiting membrane peeling, intraocular gas tamponade with 18% C3F8, and strict postoperative prone positioning for 5 days. Tapping of macular hole edges was performed on all sides using 23-gauge GreenTip soft tip cannula. Hole closure was examined postoperatively using optical coherence tomography. There were 16 females and 12 males aged 63 ± 14.38 years. The mean MHI was 0.32. Hole closure was seen in 25 eyes (89.29%). MHI was less than 0.25 in the 3 eyes with failed macular hole surgery. Epiretinal membrance (ERM) was present in 22 eyes (78.57%). The presence of ERM did not correlate with hole closure (P = 1.00). Continuity of external limiting membrane was a better predictor of functional success than inner segment/outer segment continuity (P < 0.05). Type I hole closure was seen in 20 (80%) of 25 eyes while the remaining 5 eyes (20%) had type II hole closure on optical coherence tomography. Corrected distance visual acuity improved significantly from 0.86 ± 0.2 logMAR preoperatively 0.43 ± 0.22 logMAR postoperatively (P < 0.0001). Newer technique of tapping macular hole edges provides acceptable anatomical and functional success rates even in large macular holes (MHI< 0.5).