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Karen Chia, Hon Tym Wong; Anatomic and Visual Success after Macular Hole Surgery in an Asian population. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5806. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To identify factors associated with anatomical and visual success of macular hole surgery in an Asian population.
A retrospective, interventional case series of 79 consecutive eyes with idiopathic senile full thickness macular holes treated by pars plana vitrectomy (PPV) were analysed.
The median follow-up time was 19.5 months. The mean age was 63.4 years (range 36-82 years) and there were more females (64.6%). Anatomical success was achieved in 78.5% of eyes after 1 surgery. Best corrected visual acuity (VA) improved from a median of LogMAR of 0.88 to 0.48 at last follow up. Thirty-seven eyes (46.8%) had final VA of 20/40 or better. Sixty-two (78.5%) holes were closed after 1 surgery. Internal limiting membrane (ILM) peel was performed in 70 eyes (88.6%), of which 26 had no stain and staining was used in 44 eyes (55.7%). Trypan blue was the most common stain used (35 eyes, 79.5%). Cataract, epiretinal membrane formation and high IOP were the most common complications of surgery. Hole closure correlated well with final BCVA 20/40 or better (p= 0.011, Chi-square with continuity correction, OR=7.5). Anatomical closure correlated with improvement of at least 3 lines (p=0.024) but not duration of symptoms (p=0.069). The main factors predictive for hole closure was performing an internal limiting membrane peel (p= 0.002). Pre-operative hole diameter (≤400μm) was predictive for good final VA (p=0.003), but was not correlated with anatomical closure (p=0.099). Patients with poor preoperative vision had higher likelihood of visual improvement of 3 lines or more (p=0.002) but duration of symptoms 1 year or more correlated with poor final VA (p=0.004). Final VA correlated closely with hole diameter (p=0.002) but not base diameter (p=0.253). The type of gas used, posturing technique and gauge of vitrectomy had no statistical effect on outcomes.
There was good success rates of macular hole surgery in Asians. Anatomic success was associated with ILM peel with stain. Pre-operative hole diameter (≤400μm) was predictive for good final VA.
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