Comparative Efficacy of Posterior Subtenon Kenacort Compared to Standard Surgical Treatment for Macular Hole Closure

Main Article Content

Mujjaddad Rehman
Rabia Faheem
Saif Ullah

Abstract

Background: Macular holes cause significant vision loss, particularly in older adults. Although standard surgical treatment (SDT) has been successful, there is increasing interest in less invasive treatments that might offer better outcomes, especially in terms of best-corrected visual acuity (BCVA) and macular hole closure.


Objective: This study aimed to determine the effectiveness of posterior subtenon Kenacort (SBT) in closing macular holes and to compare its efficacy with standard surgical treatment (SDT). Additionally, the study examined the impact of macular hole classification on treatment outcomes in both groups.


Methods: An interventional study was conducted at Al-Shifa Trust Eye Hospital in Rawalpindi, involving 60 subjects aged 45 to 65 years with idiopathic macular holes. Participants were selected using non-probability sampling. Group A (30 eyes) received two SBT injections three months apart, while Group B (30 eyes) underwent SDT, which included pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade. OCT imaging and logarithm of the minimum angle of resolution (LogMAR) measurements were obtained for all subjects before treatment, with follow-up assessments conducted six months post-treatment. Data analysis was performed using SPSS version 25.0, with quantitative variables expressed as mean ± SD and inferential statistics explored using ANOVA and paired sample t-tests. A p-value ≤ 0.05 was considered statistically significant.


Results: Both treatment groups had thirty patients each with similar average macular hole sizes (SBT: 436 ± 126 µm, SDT: 439 ± 127 µm). In the SBT group, average BCVA improved from 1.48 to 0.846, while in the SDT group, it changed from 1.44 to 1.25. Macular hole classification significantly affected post-treatment BCVA scores in both groups (p < 0.001). The SBT group showed significantly greater BCVA improvement compared to the SDT group.


Conclusion: Posterior subtenon Kenacort effectively closed macular holes and improved BCVA more than standard surgical treatment. Macular hole classification influenced post-treatment BCVA scores in both treatment groups, highlighting its importance in predicting treatment outcomes.

Article Details

How to Cite
Rehman, M., Faheem, R., & Ullah, S. (2024). Comparative Efficacy of Posterior Subtenon Kenacort Compared to Standard Surgical Treatment for Macular Hole Closure. Journal of Health and Rehabilitation Research, 4(2), 1111–1116. https://doi.org/10.61919/jhrr.v4i2.971
Section
Articles
Author Biographies

Mujjaddad Rehman, Pakistan Institute of Ophthalmology Pakistan.

Retina Department, Pakistan Institute of Ophthalmology Pakistan.

Rabia Faheem, Pakistan Institute of Ophthalmology Pakistan.

Internee Optometrist, Pakistan Institute of Ophthalmology Pakistan.

Saif Ullah, Pakistan Institute of Ophthalmology Pakistan.

Pakistan Institute of Ophthalmology Pakistan.

References

Wang S, Xu L, Jonas JB. Prevalence of Full-Thickness Macular Holes in Urban and Rural Adult Chinese: The Beijing Eye Study. Am J Ophthalmol. 2006;141(3):589-91.

Hubschman JP, Govetto A, Spaide RF, Schumann R, Steel D, Figueroa MS, et al. Optical Coherence Tomography-Based Consensus Definition for Lamellar Macular Hole. Br J Ophthalmol. 2020;104(12):1741-7.

Freeman WR, Azen SP, Kim JW, El-Haig W, Mishell DR, Bailey I. Vitrectomy for the Treatment of Full-Thickness Stage 3 or 4 Macular Holes: Results of a Multicentered Randomized Clinical Trial. Arch Ophthalmol. 1997;115(1):11-21.

Yuzawa M, Watanabe A, Takahashi Y, Matsui M. Observation of Idiopathic Full-Thickness Macular Holes: Follow-Up Observation. Arch Ophthalmol. 1994;112(8):1051-6.

Kelly NE, Wendel RT. Vitreous Surgery for Idiopathic Macular Holes: Results of a Pilot Study. Arch Ophthalmol. 1991;109(5):654-9.

Eckardt C, Eckardt U, Groos S, Luciano L, Reale E. Removal of the Internal Limiting Membrane in Macular Holes: Clinical and Morphological Findings. Ophthalmol Z Dtsch Ophthalmol Ges. 1997;94(8):545-51.

Sheidow TG, Blinder KJ, Holekamp N, Joseph D, Shah G, Grand MG, et al. Outcome Results in Macular Hole Surgery: An Evaluation of Internal Limiting Membrane Peeling with and without Indocyanine Green. Ophthalmology. 2003;110(9):1697-701.

Tirelli F, Sasso P, Scupola A. Idiopathic Macular Hole: Post-Operative Morpho-Functional Assessment and Prognostic Factors for Recovery of Visual Acuity. Ann Dell'Istituto Super Sanità. 2013;49:313-6.

Toklu Y, Yorgun MA, Tanrıverdi B, İçöz M. Temporal Inverted Internal Limiting Membrane Flap Technique for the Treatment of Macular Holes. Eur J Ther. 2022;28(1):73-8.

Roth M, Schön N, Jürgens L, Engineer D, Kirchhoff K, Guthoff R, et al. Frequently Assessed and Used Prognostic Factors for Outcome After Macular Hole Surgery: Which is Better? BMC Ophthalmol. 2021;21:398.

Essex RW, Hunyor AP, Moreno-Betancur M, Yek JTO, Kingston ZS, Campbell WG, et al. The Visual Outcomes of Macular Hole Surgery: A Registry-Based Study by the Australian and New Zealand Society of Retinal Specialists. Ophthalmol Retina. 2018;2(11):1143-51.

Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, et al. The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and Macular Hole. Ophthalmology. 2013;120(12):2611-9.

Ueoka K, Mizuguchi T, Horiguchi M, Ito Y. Vitreoretinal Interface Abnormalities in Fellow Eyes of Patients with a Macular Hole. Fujita Med J. 2024;10(2):64-8.

Ebrahimi Z, Torkashvand A, Zarei M, Faghihi H, Khalili Pour E, Imani Fooldi M, et al. Treatment of Inflammatory Macular Hole: Case Series and Review of Literature. Ocul Immunol Inflamm. 2022;30(4):966-72.

Garg A, Ballios BG, Yan P. Spontaneous Closure of an Idiopathic Full-Thickness Macular Hole: A Literature Review. J Vitreoretin Dis. 2021;6(5):381-90.

Byun YS, Park YH. Complications and Safety Profile of Posterior Subtenon Injection of Triamcinolone Acetonide. J Ocul Pharmacol Ther. 2009;25(2):159-62.

Llop SM, Papastefanou VP, Smith J, Narendran N. Spontaneous Closure of a Chronic Full-Thickness Idiopathic Macular Hole After Irvine-Gass Syndrome Resolution. BMC Ophthalmol. 2022;22:354.

Su D, Obeid A, Hsu J. Topical Aqueous Suppression and Closure of Idiopathic Full-Thickness Macular Holes. Ophthalmic Surg Lasers Imaging Retina. 2019;50(2).

Bonnell AC, Prenner S, Weinstein MS, Fine HF. Macular Hole Closure with Topical Steroids. Retin Cases Brief Rep. 2022;16(3):351-4.

Robles-Holmes HK, Staropoli PC, Yannuzzi N, Sridhar J. Management of Large or Recurrent Macular Holes. Curr Ophthalmol Rep. 2020;8(2):62-8.