D H Steel1,2, P H J Donachie3, G W Aylward4, D A Laidlaw5, T H Williamson5, D Yorston6. 1. Sunderland Eye Infirmary, Queen Alexandra Rd, Sunderland, SR2 9HP, UK. David.steel@ncl.ac.uk. 2. Institute of Genetic Medicine, Newcastle University, Central Pkwy, Newcastle upon Tyne, NE1 3BZ, UK. David.steel@ncl.ac.uk. 3. Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, GL53 7AN, UK. 4. Moorfields Eye Hospital, City Rd, London EC1V 2PD, London, UK. 5. Guy's and St. Thomas' NHS Foundation Trust, London, SE1 7EH, UK. 6. Gartnavel Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK.
Abstract
OBJECTIVES: To reassess the definition of a large macular hole, factors predicting hole closure and post-surgery visual recovery. DESIGN: Database study of 1483 primary macular hole operations. Eligible operations were primary MH operations treated with a vitrectomy and a gas or air tamponade. Excluded were eyes with a history of retinal detachment, high myopia, previous vitrectomy or trauma. RESULTS: A higher proportion of operations were performed in eyes from females (71.1%) who were 'on average' younger (p < 0.001), with slightly larger holes (p < 0.001) than male patients. Sulfur hexafluoride gas was generally used for smaller holes (p < 0.001). From 1253 operations with a known surgical outcome, successful hole closure was achieved in 1199 (96%) and influenced by smaller holes and complete ILM peeling (p < 0.001), but not post-surgery positioning (p = 0.072). A minimum linear diameter of ~500 μm marked the threshold where the success rate started to decline. From the 1056 successfully closed operations eligible for visual outcome analysis, visual success (defined as visual acuity of 0.30 or better logMAR) was achieved in 488 (46.2%) eyes. At the multivariate level, the factors predicting visual success were better pre-operative VA, smaller hole size, shorter duration of symptoms and the absence of AMD. CONCLUSIONS: Females undergoing primary macular hole surgery tend to be younger and have larger holes than male patients. The definition of a large hole should be changed to around 500 μm, and patients should be operated on early to help achieve a good post-operative VA.
OBJECTIVES: To reassess the definition of a large macular hole, factors predicting hole closure and post-surgery visual recovery. DESIGN: Database study of 1483 primary macular hole operations. Eligible operations were primary MH operations treated with a vitrectomy and a gas or air tamponade. Excluded were eyes with a history of retinal detachment, high myopia, previous vitrectomy or trauma. RESULTS: A higher proportion of operations were performed in eyes from females (71.1%) who were 'on average' younger (p < 0.001), with slightly larger holes (p < 0.001) than male patients. Sulfur hexafluoride gas was generally used for smaller holes (p < 0.001). From 1253 operations with a known surgical outcome, successful hole closure was achieved in 1199 (96%) and influenced by smaller holes and complete ILM peeling (p < 0.001), but not post-surgery positioning (p = 0.072). A minimum linear diameter of ~500 μm marked the threshold where the success rate started to decline. From the 1056 successfully closed operations eligible for visual outcome analysis, visual success (defined as visual acuity of 0.30 or better logMAR) was achieved in 488 (46.2%) eyes. At the multivariate level, the factors predicting visual success were better pre-operative VA, smaller hole size, shorter duration of symptoms and the absence of AMD. CONCLUSIONS: Females undergoing primary macular hole surgery tend to be younger and have larger holes than male patients. The definition of a large hole should be changed to around 500 μm, and patients should be operated on early to help achieve a good post-operative VA.
Authors: Declan C Murphy; Amar V Nasrulloh; Clare Lendrem; Sara Graziado; Mark Alberti; Morten la Cour; Boguslaw Obara; David H W Steel Journal: Ophthalmol Retina Date: 2020-06-18
Authors: Carmen Baumann; Saskia Hoffmann; Ahmed Almarzooqi; Navid Johannigmann-Malek; Chris P Lohmann; Stephen B Kaye Journal: Transl Vis Sci Technol Date: 2021-11-01 Impact factor: 3.283