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Jack Shao, Lucy Xu, Omar Punjabi, Justis Ehlers, Sunil Srivastava, Peter Kaiser; Factors that Predict Outcomes of Macular Hole Repair. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2788.
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To determine the preoperative and intraoperative factors that may be associated with anatomical and functional outcomes after surgical macular hole repair.
A retrospective, consecutive study involving 59 eyes of 58 patients, undergoing repair of idiopathic, full thickness macular holes was performed after Institutional Review Board approval was obtained. Macular hole repair was performed either by pars plana vitrectomy (PPV) or by combined cataract extraction with PPV (CE/PPV). Preoperative logMAR best corrected visual acuity (BCVA) and Ocular Coherence Tomography (OCT) characteristics of the macular holes were recorded. Main outcome measures included OCT-documented hole closure and BCVA at any point between the 1-6 month post-operative visit.
The mean preoperative macular hole minimum diameter (MD) on OCT was 327.5 um and 442.3 um, in holes that closed and did not close, respectively (p=0.10). Hole closure rate for eyes with MD < 250 um, 250 um - 400 um, and >400 um was 92%, 80%, and 83.3%, respectively (p = 0.55). The mean difference between post- and pre-operative BCVA was -0.306 (p<0.0001). The difference in BCVA change after surgery between holes that closed and those that did not was -0.29 (p=0.026). The difference in postoperative BCVA between PPV and CE/PPV groups was 0.08 (p<0.36). Pre-operative macular hole size did not affect the final visual outcome (p=0.28). Among eyes undergoing primary macular hole repair, 75% had SF6 gas infusion and 25% had C3F8. The hole closure rate for the SF6 group and C3F8 group was 92.5% and 69.2%, respectively (p =0.031). In primary repairs, 92% had ILM peel and 8% did not. The closure rate was 89.9% in those with ILM peel, and 50% in those without (p=0.024). In primary repairs, for every 100um increase in preoperative MD, there is a 0.06 improvement in postoperative BCVA (p = 0.03), and for every 100 um of preoperative IS/OS loss, there is a 0.02 improvement in postoperative BCVA (p=0.015).
Minimum diameter of macular holes was not associated with rate of hole closure. Successful macular hole closure was associated with significantly improved BCVA. Combined CE/PPV did not result in significantly better visual outcomes than PPV alone. SF6 use and ILM peel were associated with a greater rate of macular hole closure. In primary repairs, macular holes with larger preoperative MD and greater preoperative IS/OS showed greater room for improvement in postoperative BCVA.
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