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Linda Hedi Kemp, Paul Flavahan, David Yorston; Does macular hole size affect visual outcome?. Invest. Ophthalmol. Vis. Sci. 2014;55(13):303.
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© ARVO (1962-2015); The Authors (2016-present)
Studies of prognostic factors in macular hole surgery showed smaller hole size, better pre-operative vision, shorter duration, younger age, and earlier stage macular holes are all associated with better anatomical and visual outcomes. A recent study of 50 eyes found base diameter is the best predictor of anatomical and visual outcome. However, many studies are confounded by different anatomical outcomes. We performed this study to determine if these factors were useful predictors of final vision in eyes that have successful hole closure.
All eyes were examined with the Heidelberg Spectralis OCT. Minimum hole diameter, basal hole diameter and hole height were measured in accordance with published definitions. All patients who were not already pseudophakic had combined cataract surgery and vitrectomy. Following vitrectomy, the ILM was peeled, and the eye filled with C3F8 or C2F6 gas. Patients postured face down overnight following surgery, but no further posturing was required. Visual success was defined as a corrected vision of 6/12 or better. 133 eyes were included. 130 (97.7%) holes were closed with one operation. Only the 130 anatomical successes were included in analysis of visual outcomes. 65 (50%) eyes achieved a vision of 6/12 or better.
Patient age, pre-operative visual acuity, minimum hole diameter, basal hole diameter, and hole height were all entered into a logistic regression model. Only pre-operative vision (p<0.0001) and basal diameter (p=0.045) were associated with visual outcome. The pre-op vision and basal diameter were used to rank eyes by probability of visual success, and a receiver operating characteristics curve was plotted. The area under the curve was 0.75, indicating good agreement.
Previous studies have shown that anatomical closure is linked to hole diameter. As hole closure is linked to final vision, it can be a confounding factor. Since anatomical success rates of macular hole surgery are approaching 100%, it is useful to identify which factors will predict final visual acuity assuming anatomical closure. We found that pre-operative visual acuity was the most important predictor of final vision, and that hole size was less helpful. This may be explained if hole size is primarily a predictor of hole closure, and of secondary importance in predicting final vision.
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