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

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 mu m), 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 mu m 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.