Predictive Factors For Functional And Anatomical Success Following Macular Hole Surgery

Abstract

Purpose: : To identify preoperative characteristics predictive of functional and anatomical outcomes following idiopathic full-thickness macular hole (FTMH) surgery

Methods: : A pragmatic prospective randomised clinical trial, which enrolled 141 patients, was undertaken. Patients with stage 2-3 FTMH were randomised 1:1 to received internal limiting membrane (ILM) peeling or no peeling. The effect of baseline characteristics, including duration of symptoms, distance and near best corrected visual acuity (BCVA), size of the hole and surgical procedure carried out, on functional (distance visual acuity at 6 months) and anatomical (macular hole closure with a single surgery) outcomes was investigated using step-wise regression analysis.

Results: : Distance and near BCVA at baseline had the most significant p-values for association with postoperative vision, with the best vision following surgery in those patients with higher levels of vision pre-operatively. The most statistically significant factor predicting macular hole closure was the type of surgery received (ILM peel versus no peel), with a statistically significantly higher chance of hole closure in patients receiving ILM peeling at initial surgery (odds ratio 8.12, 95% CI: 3.19 - 20.67, p < 0.001), followed by the size of the hole (odds ratio 0.72 for a 100µm increase in maximum diameter, 95% CI: 0.55 - 0.95, p = 0.018).

Conclusions: : Visual acuity and peeling of the internal limiting membrane were the best predictors for functional and anatomical success following macular hole surgery in patients with idiopathic FTMH.

Clinical Trial: : http://www.clinicaltrials.gov NCT00286507

Keywords: macular holes • vitreoretinal surgery • clinical (human) or epidemiologic studies: risk factor assessment