Using Imaging Biomarkers and Anatomic Features To Predict the 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 year 2018-2019 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. Final statistical analyses are currently underway. Data will be 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 will be compared between groups using either rank-sum procedures or Fisher’s exact tests. Analyses will be performed using R (ver. 4.0.3).

Results : There were 138 subjects who met inclusion criteria and had vitrectomy for macular hole. One had a traumatic injury and was especially young (< 15 years old) at the time of repair; all others were between 42–87 years at time of surgery, with the mean age of 71.5. 69.5% of patients were female. Internal limiting membrane was peeled in all cases. Hole closure was successful for 126 subjects (90.5%); 120 (95%) of these had single surgery success. Age, lens status, prior hole repair, and chronicity (present > 1 year), pathologic myopia or staphyloma were included in data collection, among several other variables of interest. 6 (50%) of the unsuccessful surgeries were highly myopic patients and 11 of the total 17 (64.7%) highly myopic patients achieved successful closure. Mean minimum hole diameter (MHD) was 316.2 uM. A larger mean MHD was found among those who had an unsuccessful repair (598.2 uM). Mean preoperative logMAR visual acuity was 0.81 with mean improvement to 0.52 postoperatively.

Conclusions : The study suggests that factors such as being highly myopic and large MHD may portend a decreased likelihood of a successful macular hole surgery, although final statistical analyses are pending.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.