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J. Kraus, C. Framme, T. L. Jackson, H. G. Sachs, J. Roider, J. Hillenkamp; Retreatment of Full-thickness Macular Hole: Predictive Value of Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4110.
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To determine the efficacy of re-operation following failed surgery for idiopathic full-thickness macular hole with internal limiting membrane peel, and to determine if optical coherence tomography (OCT) can be used to identify those patients most likely to benefit from repeat surgery.
28 patients (28 eyes) with a persisting macular hole after vitrectomy, internal limiting membrane peel, and gas tamponade underwent repeat surgery with vitrectomy and gas or oil tamponade. Autologous platelet concentrate, autologous whole blood, or no adjuvant was used. Pre-operative OCT was undertaken in all eyes. Anatomic closure and improvement of best-corrected visual acuity (BCVA) were the main outcome measures.
Anatomic closure was achieved in 19 of 28 eyes (68%). BCVA improved in 12 eyes, remained unchanged in 9, and worsened in 7. BCVA improved in 11 of 19 eyes with anatomic closure, and in 1 of 8 eyes without closure. Anatomic closure and improvement of BCVA correlated with pre-operative macular hole configuration on OCT, with higher rates of closure in eyes with a cuff of subretinal fluid at the break margin (p<0,05). Macular hole size, type of tamponade or pre-operative BCVA did not significantly correlate with visual or anatomic outcome.
Re-operation for persistant macular hole has a lower anatomic and visual success rate than primary surgery. Macular hole configuration seems to be a strong prognostic indicator of anatomic closure and may help identify those patients most likely to benefit from re-operation.
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