Factors Predicting Success of Macular Hole Repairs

Abstract

Purpose : Despite growing literature looking at factors that contribute to the closure of full-thickness macular holes, there are still gaps in our knowledge. This study sought to examine the role of preoperative and intraoperative factors in predicting anatomic and visual success of vitrectomy for full-thickness macular holes.

Methods : A retrospective chart review of cases in calendar 2019 was conducted at the University of Wisconsin. Inclusion criteria included vitrectomy for macular hole and pre- and post-operative imaging. Successful closure was defined as the absence of a full-thickness disruption by imaging. Data was summarized using the median and inter quartile range (IQR; span from 25^th to 75^th percentile capturing central 50% of the sample) for continuous features or with frequencies and percentages for categorical factors. Risk factors associated with hole closure were compared between groups using either rank-sum procedures or Fisher’s exact tests. Odds ratios and supporting 95^th confidence intervals (CI₉₅) were computed for categorical factors by inverting Fisher’s exact test or using logistic regression with Firth’s correction in cases where the explanatory factor had more than two levels and data especially sparse. Analyses were performed using R (ver. 4.0.3).

Results : There were 64 subjects who met inclusion criteria and had vitrectomy for macular hole (Table 1). One had a traumatic injury and was especially young (< 15 years old) at the time of repair; all others were between 48.8–87.4 years at time of surgery. Internal limiting membrane was peeled in all cases (1 in a prior surgery). Hole closure was successful for 57 subjects (89%); 55 (86%) had single surgery success. Age, lens status, prior hole repair, and chronicity (present > 1 year) were not associated with the outcome (p > 0.10 for each). Pathologic myopia or staphyloma (n=8, 12.5%) was associated with lower odds of success (OR=0.14; CI₉₅: 0.02-0.86, p = 0.036). Median minimum hole diameter (MHD) was 335.2 uM. Larger MHD was greater among those who had an unsuccessful repair, but not significantly (p = 0.071). Data suggest an estimated 71% (CI₉₅: 42-100%) chance a subject with an unsuccessful outcome would have a larger MHD.

Conclusions : The study suggests that the factors that portend a decreased likelihood of a successful macular hole surgery include pathologic myopia/staphyloma and larger MHD.

This is a 2021 ARVO Annual Meeting abstract.