Abstract
Purpose :
Various surgical techniques have been described to treat full thickness macular holes (FTMH) which do not close after initial surgery; however no consensus has been reached regarding the optimal approach. We performed a retrospective, observational study to determine the outcomes of persistent FTMH treated by vitrectomy, radial retinotomies, gas tamponade, and prone posturing.
Methods :
All patients who had reoperation after failed primary idiopathic FTMH repair between 2011 and 2017 were identified. Demographic data were recorded and case records reviewed to identify visual acuity, chronicity, optical coherence tomography (OCT) measurements, surgical procedure, interval between operations, and final outcome.
Results :
22 eyes of 21 patients were identified (19/21 female, mean age 67) who underwent primary PPV, ILM peel and gas tamponade (with phacoemulsification if phakic). Primary surgery was carried out by consultant vitreoretinal surgeons and fellows within a single tertiary centre. Secondary surgery was performed by a single consultant vitreoretinal surgeon.
Median visual acuity on presentation was 1.0 (LogMAR), improving to 0.6 (LogMAR) on discharge (Wilcoxon test, p=0.0037). Closure was achieved in 18 out of 22 eyes (82%) after radial retinotomy. The median minimum linear diameter of FTMH prior to initial surgery was 550µm.
There was a mean interval of 6.8 weeks between procedures (range 3-24 weeks). Where possible the ILM peel was extended (7/22, 32%), and in all cases 6 - 8 partial thickness radial retinotomies were performed at the edge of the open hole. The mean follow up interval for closed holes was 10 months.
Probability analysis based on pre-operative findings showed that 44.4% of patients would be expected to have a final visual acuity of 0.3 or better, assuming primary hole closure. 5/18 (27.8%) patients achieved this, and this difference is not statistically significant (Fisher’s exact test, p = 0.48).
Conclusions :
This technique facilitates FTMH closure in eyes which have had previous extensive ILM peel, with greater success when surgery is performed within 8 weeks. Visual outcomes are comparable with alternative techniques for repair of FTMH after failed primary surgery, and are similar to the expected outcomes after primary hole closure for these large holes.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.