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Julia Mathew Padiyedathu, Anna Gabrielian; Post-operative restoration of macular microstructure: visual & anatomic outcomes of macular hole surgery at the New York Eye and Ear Infirmary. Invest. Ophthalmol. Vis. Sci. 2014;55(13):304.
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© ARVO (1962-2015); The Authors (2016-present)
The evaluation of anatomic and visual outcomes in macular hole cases treated surgically at the New York Eye and Ear Infirmary from 2006 to 2012.
33 eyes of 30 patients with the diagnosis of non-traumatic macular hole that underwent pars plana vitrectomy (PPV), membrane peel, gas/silicone oil tamponade, with at least 6 months of follow-up were included in this retrospective study. Pre- and postoperative macular assessment was conducted with spectral-domain optical coherence tomography (OCT). Sub-group analysis was performed on post-operative microstructural anatomy and its association with post-operative visual outcomes.
The mean age was 62.7 years and 25 patients (83%) were female. All patients underwent PPV with internal limiting membrane peel, 31 eyes (96%) had intraocular gas tamponade, and 2 eyes (6%) underwent silicone oil tamponade. Vision improved in 23 eyes (70%), stayed the same in 6 eyes (18%), and became worse in 4 eyes (12%). The mean improvement in BCVA was 0.4 logMAR units. There was successful closure of macular holes in 27 eyes (82%). In 6 eyes (18%) the macular holes remained open. Fifty percent of the holes that remained open were in eyes undergoing reoperation. For the microstructural outcome sub-analysis, 9 of 33 eyes were excluded due to lack of data or lack of MH closure. Of the remaining 24 eyes, 17 eyes (71%) had successful restoration of the IS/OS junction, with a mean post-op BCVA of 0.4 logMAR units (mean improvement in BCVA of 0.3 logMAR units). In 7 eyes (29%), the IS/OS junction was absent, abnormal, or defective, with a mean post-op BCVA of 0.6 logMAR units (mean improvement of BCVA of 0.8 logMAR units).
Surgical repair of macular holes leads to an improvement of vision in the majority of cases. Closure of macular holes is achieved after vitrectomy. Prior unsuccessful surgical repair of macular hole is associated with failure to achieve macular hole closure. Successful restoration of microstructural retinal architecture is associated with improved visual acuity.
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