Anatomical and functional outcomes of macular hole surgery in a single VR unit (2005-2012)

Abstract

 

Purpose

 

To assess the anatomical and functional outcomes of macular hole surgery with 20G pars plana vitrectomy (PPV) +ILM peeling and gas tamponade in a single unit (2005-2012).

 

Methods

 

Clinical and surgical data were prospectively entered in electronic medical records. Data collection included: demographic details, stage of macular hole, tamponade type, phakic status, preoperative and postoperative visual acuity (VA), anatomical success rate, secondary cataract surgery rate and intraoperative and postoperative complication rates.

 

Results

 

301 eyes of 278 patients with a mean age of 69.3 ±8.23 years (mean ±SD)(median: 69) and a 1:2.5 male to female ratio were included. Macular holes were stage II in 28.7% of eyes, stage III in 57.5% and stage IV in 14.7%. Preoperative mean VA was 0.88±0.32 logMAR, and postoperative VA was 0.77±0.27 at 1st, 0.65±0.29 at 3rd, 0.60±0.30 at 6th, 0.47±0.27 at 12th and 0.46±0.28 at 24th month. Complete closure with flattening against the retinal pigment epithelium was achieved in 73.3% of eyes at 1st, 88.7% at 3rd, 90.3% at 6rd and 91.6% at 12th months, with an overall final closure rate of 92.9% (97.1% for stage II, 91.3% for stage III and 85.3% for stage IV, p:0.06). Primary PPV success rate was 92% (230/251) with a failure rate of 8% (4.4% for stage 2, 9.4% for stage 3 and 11.8% for stage 4, p:0.16). 52% (11/21) of patients with primary failure declined further interventions. Secondary PPV success rate was 40% (4/10) and 1 patient required a 3rd intervention. Intraoperative complications rate (25.2%, most commonly iatrogenic retinal tears) were associated with surgeon experience (consultants 18.5% vs fellows 33.8%, p:0.002) and lens status (phakic 28.9% vs pseudophakic 14.6%, p:0.050). Post-operative retinal detachment occurred in 0.8% (2/251 eyes).

 

Conclusions

 

Macular hole surgery provides good anatomical and functional outcomes. Operative complications were common but rarely visually significant.

 

 

Best corrected visual acuity (BCVA) at different timepoints, preoperatively (Baseline) and postoperatively (1, 3, 6, 12, 24 months). Overall data and per Macular hole stage.

 

 

Closure rate at different timepoints (1, 3, 6 and 12 months, overall data). Data show as percentage of closed (green), closed with persistent foveal detachment (yellow) and open (red) macular hole rates post-surgery.

 

Keywords: 586 macular holes • 762 vitreoretinal surgery • 462 clinical (human) or epidemiologic studies: outcomes/complications