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Teresa M. Jenisch, Michael Koller, Florian Zeman, Horst Helbig, Wolfgang A. Herrmann; Macular Hole Surgery: An Analysis Of Risk Factors For The Anatomical Outcome With A Special Emphasis On The Role Of The Learning Curve. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2616.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the learning curve and other influencing factors on the anatomical outcome in macular hole surgery
In this retrospective cohort study 225 eyes of 225 consecutive patients with previous macular hole surgery for idiopathic macular hole were included. The mean follow up was 4,9 months (SD+/-3,54). Main outcome measures included the rate of macular hole closure. The following risk factors for non-closure were examined: experience of the surgeon (inexperienced : initial 30 operations ), size of the hole, age of patient, gender, epiretinal membrane, tamponade, dye, 20 vs. 23 gauge, combination with cataract surgery, operation time. The operations were performed by one experienced senior vitreoretinal surgeon and five vitreoretinal surgeons in their training phase. All eyes underwent three port pars plana vitrectomy with internal limiting membrane peeling and intraocular gas tamponade. All patients underwent preoperative measurement of the maximum macular hole diameter and postoperative control measurement using optical coherence tomography (Stratus OCT, Carl Zeiss Meditec, Jena, Spectralis OCT, Heidelberg Engineering, Heidelberg).
In 194 of 225 patients closure of the macular hole could be achieved (86.2%). No reopening of initially closed macular holes was observed in any eyes. Retinal detachment occurred in 8/225 eyes (3.6 %).Univariate logistic regression analyses were calculated with each of the risk factors mentioned above.The only variables that yielded significant effects were size of the hole per 100µm (OR: 2.24; p < 0.001) and experience of the surgeon (OR: 0.390; p = 0.038). The larger the hole and the less experienced the surgeon, the greater the likelihood that the hole remained open. Both factors were entered in a multiple logistic regression. Size of the hole per 100µm emerged as the only statistically significant risk factor with an OR of 2.24 (CI95 1.647 - 3.296, p < 0.001). Little experience results in an OR of 2.18 (CI95 0.78 - 6.09, p = 0.137), indicating an increased risk for non-closure of the hole.
Main risk factors for non-closure as a result of macular hole surgery were the size of the hole and the experience of the surgeon. However, surgeons in training achieved an acceptable closure rate during their initial operations.
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