Treatment of Chronic Large and Persistent Macular Hole by a new technique in a Tertiary Care Hospital

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 >_ 400 & micro;m) 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 & micro;m and basal diameter of 849.4 +/- 92.6 & micro;m, 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.