Visual results of macular hole surgery from a registry-based study by the Australian and New Zealand Society of Retinal Specialists

Abstract

Purpose : To present the visual results of macular hole surgery in primary idiopathic macular holes. To describe the temporal pattern of post-operative visual recovery, and to explore the effect of pre-operative clinical covariates, and of surgical technique, on the visual outcome.

Methods : Baseline demographic and clinical information was collected, as well as details of surgical intervention and post-operative posturing advice. Primary follow up data was collected at 3 months post-operatively. Only those with primary idiopathic holes were included in the analysis. Linear regression was used to explore the effects of covariates on visual outcome, and lowess smoothing was used to graphically present the temporal pattern of visual recovery.

Results : A total of 2456 eyes of 2367 patients was included in the study. Outcomes were available in 94.9% of cases (2330/2456). The rate of macular hole closure (=success) was 95.0% (2214/2330). The mean baseline acuity was 48.3 letters. The mean improvement in acuity in successful cases was 16.1 letters, vs. a 4.5 letter deterioration in unsuccessful cases (P<0.001). Considering only eyes with successful outcomes (n=2214), and correcting for duration of follow up, the following were associated with better post-operative acuity: better pre-operative acuity (P<0.001), younger age (P<0.001), shorter duration of hole (P<0.001), smaller hole (P<0.001), pseudophakic lens status (P<0.001), SF6 gas use (P<0.001 vs. longer acting gas). The analysis was repeated in pseudophakic eyes only and SF6 use was no longer significant. Face-down positioning, gender and vitreous attachment to hole margin were not associated with visual outcome. The temporal pattern of visual recovery will be presented graphically by lens status.

Conclusions : A number of previously unreported baseline covariates were observed to be associated with outcome. SF6 gas use was associated with better visual outcomes in phakic eyes only, suggesting longer acting gases may be contributing to cataract formation. Face-down positioning was not protective. The better visual recovery in pseudophakic eyes, and the lack of the need for further surgery present a strong argument for combined phaco-vitrectomy surgery in phakic eyes with macular hole.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.