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A. B. Benkoff, F. A. Folgar, J. Weissbrot, K. J. Wald; Macular Hole Surgery Prognostic Success Rates Based on Macular Hole Size. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1319.
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To evaluate the correlation between macular hole (MH) surgery outcomes and preoperative factors believed to affect surgical success rates.
A retrospective, consecutive, interventional case series was designed to evaluate eyes that underwent surgical repair for idiopathic stage III or IV full-thickness MH with 25-gauge pars plana vitrectomy. Eyes were classified as either success or failure based on anatomically successful closure at 3-month follow-up, as determined by optical coherence tomography (OCT). Preoperative factors were recorded for each eye: estimated duration from diagnosis to surgery, visual acuity (VA), and MH diameter measured by OCT at the base and the widest midpoint.
A total of 153 eyes were enrolled from November 2003 to June 2009. Anatomic success occurred in 143 eyes (93.5%) and failure occurred in 10 eyes (6.5%). Mean duration prior to surgery was 16.2 ± 23.2 versus 27.8 ± 27.7 weeks, for MH success and failure, respectively (p=0.13, did not reach significance). Mean VA was 0.94 ± 0.51 versus 1.30 ± 0.66 logMAR scale, for MH success and failure, respectively (p=0.03). Mean mid-hole diameter was 464.0 ± 248.0 versus 646.5 ± 115.0 microns (p<0.001), and mean base-hole diameter was 809.5 ± 381.5 versus 1254.5 ± 211.2 microns (p<0.001), for MH success and failure, respectively. There were no failures among 86 eyes with mid-hole diameter <500 microns (0%), and 10 failures among 67 eyes with mid-hole ≥500 microns (14.9%). There were no failures among 34 eyes with base-hole diameter <500 microns (0%), one failure among 72 eyes with base-hole 500-999 microns (1.4%), and 9 failures among 47 eyes with base-hole ≥1000 microns (19.1%). Stratification of VA and estimated duration did not yield any significant difference in success rates.
Preoperative visual acuity, widest mid-hole diameter, and base-hole diameter are correlated with anatomic success in MH surgery. An excellent surgical prognosis exists for MHs with mid-hole diameter <500 microns and base-hole <1000 microns. Our study suggests success rates of approximately 85% for MHs with mid-hole diameter ≥500 microns and 80% for MHs with base-hole ≥1000 microns.
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