Abstract
Objective:To assess the anatomical and functional outcomes of treating chronic persistent large macular hole by macular hole hydrodissection technique in a tertiary eye care hospital.Methods:This interventional case series study was conducted in the Vitreoretinal department of LRBT Tertiary Teaching Eye Hospital, Karachi, from October 2017 to March 2018, with follow-ups till February 2019. The study included eighteen cases of chronic (symptoms of loss of central vision ≥ 2years), persistent (previously failed macular hole surgery), large (aperture diameter of ≥ 400µm) macular hole. Out of the eighteen patients, eight (44.4%) were males and ten (55.6%) were females. All operated patients underwent macular hole hydrodissection by balanced salt solution using a silicone soft tip extrusion cannula. Patients were followed up post operatively to assess post-operative complications and surgical results.Results:Among eighteen patients with a mean aperture diameter of 477.1±102.9 µm and basal diameter of 849.4± 92.6µm, complete anatomical closure was achieved in sixteen (88.8%). Five (27.7%) out of the eighteen patients achieved best corrected visual acuity improvement of 6/36, whereas seven (38.8%) patients reached up to a BCVA of 6/60, with maximum improvement of two lines. The mean post-operative follow-up was 332.3± 46.7 days.Conclusion:Macular hole hydrodissection is a relatively new emerging technique with promising results for the closure of chronic persistent large macular hole.
Highlights
Macular hole is one of the chief vitreoretinal disorders which cause metamorphopsia and deprived central vision in the elderly.[1]
The overall incidence is approximately 3.3% per 1000.2 The pathogenesis of idiopathic macular hole has been ascribed to the presence of tangential and anteroposterior traction on the fovea by pre foveal cortical vitreous.[3]
Vitreous surgery was first described as a probable treatment for Full-Thickness Macular Holes (FTMHs), it has become a customary surgical procedure
Summary
Macular hole is one of the chief vitreoretinal disorders which cause metamorphopsia and deprived central vision in the elderly.[1] The overall incidence is approximately 3.3% per 1000.2 The pathogenesis of idiopathic macular hole has been ascribed to the presence of tangential and anteroposterior traction on the fovea by pre foveal cortical vitreous.[3] It has been postulated that the principal factors for spontaneous closure of macular hole are release of vitreofoveal traction or glial proliferation.[4]. Vitreous surgery was first described as a probable treatment for Full-Thickness Macular Holes (FTMHs), it has become a customary surgical procedure. Pak J Med Sci July - August 2021 Vol 37 No 4 www.pjms.org.pk 979 surgical techniques, approximately 90% of FTMHs attain anatomical closure on primary surgery, with almost half of patients achieving visual acuity of 20/50 or better.[5] The closure rate and visual outcome of FTMHs depend on its size and chronicity. Literature has reported a closure rate of 33% to 80% and 56% for chronic and large macular holes.[6,7] The rate of closure is further compromised in the mutual presence of risk factors including large aperture diameter, chronicity and previously failed surgery for multipart cases of macular hole.[8]
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