During Retina Subspecialty Day, Carsten H. Meyer, MD, presented a subretinal hydrodissection method for managing chronic full-thickness macular holes. The working theory? Firm adhesions between the retina and the retinal pigment epithelium (RPE) prevent closure in persistent holes, which tend to be older and larger than those that are closed using traditional methods, such as vitrectomy.
Technique details. First described by Gonvers and colleagues in 2002, the method involves placing a small decalin bleb over the macular hole. Next, three small subretinal blebs are created around the hole, which releases the adjacent retina from the RPE. This results in a mobile retina that can be shifted to cover the fovea. Either gas or silicone oil tamponade can be used, depending on surgeon preference and experience.
A global perspective. In collaboration with 29 surgeons from 11 countries, Dr. Meyer shared data from 126 persistent macular holes that were managed using this approach. Within the cohort, baseline mean hole size was 1,100 µm. At six weeks post-op, 105 (83.3%) achieved closure. All holes smaller than 1,055 µm attained anatomic closure, and the largest closed hole was 4,344 µm. Patients, on average, gained 3.9 lines of visual acuity.
Factors to consider. Idiopathic holes were more likely to achieve closure than secondary holes (87.7% vs. 60%, respectively), according to Dr. Meyer’s observations. Risk factors for failure among idiopathic holes included longer hole duration and larger size. Secondary holes in eyes with high myopia and trauma were less likely to attain anatomic success.
To conclude, Dr. Meyer reiterated that existing data support the use of this approach in eyes with refractory holes. “Subretinal hydrodissection will release firm adhesions, stretch the existing retina, and close persistent macular holes,” he said. —Keng Jin Lee.
Watch Retina Subspecialty Day. If you are registered for AAO 2020 Virtual, you have access to the archived presentations on the virtual meeting platform until Feb. 15, 2021. Log in to the virtual meeting platform: Next, from the Lobby screen, select “Sessions” from the top navigation; click “Agenda” from the drop-down menu; and click on the “Friday” tab.
Financial disclosures. Dr. Meyer: None.
Read more news from AAO 2020 Virtual.