Purpose
While large studies for surgical outcomes of idiopathic macular holes have shown significant beneficial outcomes, little is known about surgical outcomes of atypical macular holes. The purpose of this study is to evaluate outcomes of surgical intervention in atypical macular holes.
Methods
A retrospective chart review of patients from a large private retinal practice from 2005 to 2012 revealed 24 patients with atypical macular holes. The patients were grouped into underlying etiology of macular hole development (post retinal detachment repair, epiretinal membrane, myopic degeneration, proliferative diabetic retinopathy with tractional retinal detachment, trauma, diabetic macular edema, and post-cataract surgery dropped nucleus) for analysis. The lone exclusion criteria was diagnosis of an idiopathic macular hole. The intervention was pars plana vitrectomy (20-gauge, 23-gauge, or 25-gauge) with internal limiting membrane peel. The primary outcome measure was change in pre-op visual acuity (VA) to post-op VA measured at 6 months, 12 months, and 24 months (assessed with current correction or pinhole) evaluated by a mixed model repeated measures regression model with an autoregressive covariance structure. A second outcome measure, anatomic closure of the hole by OCT, was also evaluated.
Results
Overall, post-operative mean VA improved from 20/300 pre-operatively to 20/220 at 6 months (p=0.907), 20/121 at 12 months (p=0.0047), and 20/143 at 24 months follow-up (p=0.0291). Of all the patients in the study, 16 had VA improvement (66.7%), 4 had stabilization of their VA (16.7%), and 4 showed declines in their BCVA (16.7%) at their latest post-operative visit. All but two patients had anatomic closure of their macular holes (91.7% closure rate). Compared with mean pre-operative VA, all groups showed improvement at their latest measured VA.
Conclusions
Our results show surgical management of atypical macular holes yields improvements in best-corrected visual acuity when compared to pre-operative values and leads to high macular hole closure rates after vitrectomy with membrane peeling.