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Ram Peddada, Gage Alvernaz, Suneal Peddada; Idiopathic Macular Hole Repair: A non-linear relationship between pre-operative and post-operative visual acuity. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2831.
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To determine the change in visual acuity following macular hole repair and determine its association with pre-operative visual acuity.
A retrospective single surgeon consecutive case series over a 12 month period is examined with regards to change in visual acuity following repair of full thickness macular holes. In all 17 eyes of 17 patients were reviewed. Standard 25 gauge pars plana vitrectomy was performed in combination with internal limiting membrane peeling assisted by indocyanine green dye and C3F8 gas injection at 16% in all cases. Inclusion criterion was patients must have a full thickness macular hole on OCT regardless of size. Exclusion criterion was follow up period less than 6 months. Pre-operative visual acuity obtained within a month of the surgery (independent variable) and the improvement in best corrected post-operative visual acuity (dependent variable) obtained within 6 months of the study were compared to obtain a quadratic correlation coefficient.
Visual acuity improved in 16 out of 17 or 83.3% of the patients in the study. 11 out of 17 (about 65%) patients achieved 20/50 or better vision. Average visual acuity pre-operatively was 20/125 which improved post-operatively to 20/60. A correlation between the pre- and post-operative logMAR visual acuity shows a strong positive correlation coefficient, r of 0.65 or r2 of 0.42 at a p value of 0.001. A correlation of change in vision with pre-operative vision (quadratic correlation coefficient, r = 0.5 at a p = 0.01) shows a better pre-operative visual acuity leads to a greater improvement in vision. However, there is a non-linear trend of vision improvement. The improvement in visual acuity with surgery slows down as pre-operative vision worsens and eventually plateaus in the 20/125 to 20/200 range. Beyond 20/200 there is a greater scatter and unpredictability in post-operative visual acuity.
The study shows that the degree of visual acuity improvement following repair of idiopathic macular holes with vitrectomy is dependent on pre-operative vision. This trend is non-linear: it slows down with worsening pre-operative vision, then plateaus in the 20/125 to 20/200 region. Beyond 20/200 the improvement in post-operative visual acuity is still positive, but becomes unpredictable.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
The degree of improvement plateaus between 20/125 and 20/200 beyond which results become more unpredictable.
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