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Athanasios Vachtsevanos, Vaggelis Lokovitis, Solon Asteriades, Athanasios Vakalis, Dimitrios Koreas, Stavrenia Koukoula, Tranos Paris; Predisposing factors and prognosis of postoperative foveal detachment following successful macular hole (MH) surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):316.
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To identify pre- and intraoperative risk factors that predispose to outer retinal fluid development following successful macular hole surgery. The natural course of the foveal detachment was also investigated.
Thirty four eyes of 33 patients that underwent pars plana vitrectomy for idiopathic MH were studied. Best corrected visual acuity (BCVA), and Spectralis SD-OCT images were examined preoperatively and at 1, 3, 6 months postoperatively. Patients’ demographic characteristics, stage of macular hole and differentiation between surgeons regarding surgical technique were also recorded. Correlation between postoperative foveal detachment and the above possible explanatory variables were evaluated.
Postoperative presence of outer retinal fluid was observed in 13/34 (38%) eyes. In 9/13 of those eyes foveal detachment disappeared by 6 months but one patient developed lamellar hole leading to full thickness MH 26 months following initial surgery. Preoperative BCVA was 0.55 ± 0.23 improving to 0.33±0.2 in the final follow up. Postoperative VA was better in eyes that did not developed postoperative foveal detachment (0.40 ±0.23 vs 0.32±0.20) but did not reach statistical significance (p=0.30). Development of postoperative foveal detachment was associated with preoperative foveal vitreomacular traction (p=0.048), stage II MH (p=0.017) and smaller size of the closest distance between the MH edges (p=0.046).
Postoperative foveal detachment is a common finding following successful MH surgery. Meticulous evaluation of preoperative clinical and OCT findings may disclose risk factors associated with this condition.
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