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

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.