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S. M. Wren, S. Shah, A. Kumar, L. Membrey, A. Laidlaw; Determining Success of Macular Hole Surgery by OCT Maximum Linear Hole Diameter. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4120.
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Several factors including age and stage of hole, inner limiting membrane peeling, and posturing are thought to predict the outcome of macular hole surgery, there is however no single reliable prognostic factor to refer to when advising patients about the potential success of surgery on their eye. The OCT maximum linear hole diameter has recently been suggested to predict the outcome of surgery and is a simple and repeatable measurement to perform. This study aimed to investigate its reliability.
In a prospective study of 67 consecutive patients undergoing macular hole surgery with simultaneous phacoemulsification IOL (if phakic) ICG assisted ILM peeling, C3F8 and no post-operative posturing were studied. OCT maximum linear hole diameter was measured pre-operatively as were the other recognised demographic and ocular potential predictors.
The overall success of closure was 84%. Using a multivariate analysis, maximum linear hole diameter was the potential predictor most strongly associated with surgical outcome. These data were used in a logistic equation to determine chances of surgical success. The model showed a closure rate of 99% for holes of 200µm, 97% for holes of 300µm, 92% for 400µm 81% for 500µm and 615 for 600µm. There was a strong correlation of the macular hole diameter to the success of surgery, measured by the anatomical closure (p=0.002). This model was then tested for its reliability using a Hosmer-Lemeshow Test, which demonstrated a goodness of fit. (Sensitivity 98.2% and specificity 36.3%).
The model needs further refinement. Measurement of OCT maximum linear hole diameter may prove to be our most valuable tool when counselling patients and comparing surgical techniques for macular hole surgery.
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