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Rohit Chandra, Charles Pophal, Alexander G. Miller, Joan H Hornik, Jerome P Schartman, Joseph M Coney, Lawrence J Singerman, David G Miller; Efficacy of Macular Hole Surgery in Patients with Idiopathic Macular Telangiectasia Type 2. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5777.
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© ARVO (1962-2015); The Authors (2016-present)
Patients with idiopathic macular telangiectasias (IMT) type 2 can also develop full thickness macular holes (FTMH). We performed a retrospective, observational study to assess whether surgery made an impact on vision in patients with both IMT and FTMH.
After IRB approval, 11 years of data from a large retina clinic were reviewed for patients with IMT and FTMH, yielding 12 who elected for surgery and 26 who opted for medical management (MM). Age, sex, and length of follow-up were recorded. In surgical patients, best corrected visual acuity (VA) was measured at pre-surgery, 3 months after, 12 months after, and most recent follow-up. In MM patients, VA was recorded at diagnosis and most recent follow-up. Snellen VA was converted to LogMar values. Mean change in VA was compared between the groups using an unpaired t-test. We also compared surgery group VAs at 3 and 12 months, using a paired T-test to see whether a significant change in VA occurred. Choroidal neovascularization (CNV) development and change in OCT scans on a 3-point scale were both recorded.
Data showed the average age to be similar in surgery and MM patients (71 years and 69 years, respectively). The surgery group had 4 males (40%) and 6 females (60%); the MM group, 16 males (64%) and 9 (36%) females. Average length of follow-up was 44 months for the surgery group and 22 for MM. There was no statistically significant difference (p=0.830) in change of VA between the surgery group (-0.013±0.2 LogMar units) versus the MM group (+0.004±0.2 LogMar units). Within the surgery group, comparing VA at 3 months (-0.005±0.3 LogMar units) and 12 months (-0.085±0.3 LogMar Units) after surgery showed a nonsignificant change (p=0.717 and 0.547, respectively). Post-op complications were seen in 2/ 12 patients (1 macular hole revision and 1 iridotomy for acute angle closure glaucoma). OCT scans showed a 1-step improvement in FTMH of 10/11 patients who had surgery and no improvement in MM patients. CNV developed in 1/12 surgical patients and 5/26 MM patients.
In these patients with IMT and FTMH, OCT scans improved with surgery, but VA did not. There does not appear to be any benefit to surgery over observation in these cases. A prospective trial should be explored to evaluate whether there is any therapeutic value in incorporating vitrectomies into the complex management of a patient with IMT and FTMH.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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