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Ron A Adelman, Barbara Parolini, Zofia Michalewska, Didier Ducournau, ; An international multi-center investigation of macular holes: the European Vitreo-Retinal Society Macular Hole Study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):314.
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To investigate factors associated with outcome of macular hole repair.
An international collaborative multi-center non-randomized clinical study spanning 4 continents. Symptoms, signs, techniques, dyes, tamponades, post-operative positioning, success rate and complications were evaluated.
4207cases of idiopathic macular hole were enrolled by 140 retina specialists from 28 countries. 85.7% of holes closed following vitrectomy and 59% gained at least 3 lines of visual acuity. After multivariate regression, predictors for hole closure include earlier stage, shorter duration of hole and staining (p<0.001). There was no statistically significant difference among dyes including ICG, trypan blue, brilliant blue and other dyes. Staining improved anatomical outcome, but it did not affect visual outcome. There was no statistically significant difference in success rate among a variety of tamponades. Factors associated with better visual outcome include: hole closure, better baseline visual acuity, earlier stage and shorter duration of hole (p<0.001). 6% of cases had Inverted ILM flap technique that was associated with good anatomical and visual outcome. Retinal tear was noted in 3.2% of cases.
Early repair of macular hole was associated with a better visual outcome. Staining improved anatomical success but not visual success. There was no statistically significant difference among dyes. Inverted ILM flap technique may be a promising technique for large macular holes.
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