Abstract
Purpose :
Management of non-closing full thickness macular holes (MH) varies across institutions. We reviewed cases of non-closing MH repair at Vistar Eye Center (VEC), private Ophthalmology practice with six vitreoretinal surgeons. Our goal was to survey surgical techniques, evaluate outcomes, and identify possible determinants of hole closure at our institution.
Methods :
Among all cases of MH repair performed at VEC from 10/01/2018 to 09/30/2023, we identified eyes with non-closing MH after initial repair, undergoing second repair at VEC. We retrospectively reviewed charts and analyzed MH aperture size, preoperative best corrected visual acuity (BCVA), details of surgical technique at initial and second repair, and anatomical and BCVA outcomes 3 months after second repair.
Results :
Out of 610 eyes with MH repaired at VEC, we identified and analyzed 24 eyes (3.93%) with non-closing MH undergoing second repair at VEC. The mean patient age was 69.4 years. Mean initial MH aperture size was 358um. Mean initial BCVA was 0.84 logMAR. As initial surgery, all eyes underwent pars plana vitrectomy (PPV)/internal limiting membrane (ILM) peel/gas tamponade; 2/24 eyes also underwent ILM hinge flap. Initial surgery tamponade agent was SF6 in 22/24 eyes, C3F8 in 2/24 eyes. Second MH repair technique was PPV/wide ILM peel/gas tamponade in 18/24 eyes, PPV/ILM free flap/gas tamponade in 6/24 eyes; tamponade agent was C3F8 in 20/24 eyes, SF6 in 4/24 eyes. After second repair, MH closed in 17/24 (70.8%) eyes. Between eyes with closed vs persistent MH, time to second repair was 94.2 days vs 80.4 days, MH size at the time of second repair was 403um vs 566um. In both groups, the most common surgical technique was wide ILM peel (14/17 (82.4%) eyes vs 4/7 (57.1%) eyes), the most common tamponade agent was C3F8 (15/17 (88.2%) eyes vs 5/7 (71.4%) eyes). The average BCVA changed from 0.78 logMAR at initial presentation to 0.67 logMAR after second surgery in eyes with closed MH, from 1.0 logMAR to 0.92 logMAR in eyes with persistent MH.
Conclusions :
Non-closing MH closure rate after second repair was 70.8%. Eyes with persistent MH were associated with larger preoperative MH size, with worse initial BCVA and with minimal improvement after second repair. Surgical technique was similar between the two groups, with most eyes undergoing PPV and wide ILM peel with C3F8 tamponade. More research is necessary to identify techniques leading to better surgical outcomes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.