Outcomes of macular hole surgery: implications for surgical management and clinical governance (original) (raw)
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Visual and anatomical outcome of macular hole surgery at a tertiary healthcare facility
Pakistan journal of medical sciences
To assess visual and anatomical outcome of full thickness macular hole (FTMH) surgery with ILM peeling using brilliant blue G dye. Thirty patients who had clinically evident macular hole were selected. Pre-operative Optical Coherence Tomography (OCT) was done. In all cases vitrectomy was performed via 23guage 3 ports pars plana (3PPV) vitrectomy system and Brilliant blue G dye, 0.5ml dye was injected over macula which resulted in light blue stain of ILM and peeling was performed around hole in circular motion and after gas fluid exchange gas tamponade with SF6 was done. Final visual and anatomical outcome was measured as postoperative BCVA and postoperative OCT at three months respectively. Descriptive statistics were computed. Paired t-test was applied. P value≤0.05 were considered as significant. There were 12 male and 18 female patients. The mean age was 57.40±4.76 years. The mean size of macular hole was 452.20±242.33μm. The mean duration of symptoms was 16.73±13.49 weeks. Mean ...
2020
Background: To identify prognostic preoperative and intraoperative factors for anatomical and visual success of idiopathic macular hole (MH) surgery. Methods: We conducted a non-randomized, collaborative multicenter study using data of 4207 MH surgery from 140 surgeons. Main study outcomes were anatomical closure and best corrected visual acuity (BCVA) improvement postoperative at 6-12 months. Results: Information on anatomical success was available for 4138 eyes of 4207 operations. Anatomical closure of MH was achieved in 85.7% (3546 eyes). Closure was higher in smaller MH (stages 1-2 versus stage 3: OR=0.35; stage 2 versus stage 4: OR=0.16, and in MH with shorter duration before the operation (OR=0.94). Macular Holes were more likely to close when dyes were used to facilitate internal limiting membrane (ILM) peeling (odds ratio=1.73 to 3.58). The most important predictors of postoperative BCVA were the preoperative BCVA (estimate=0.39, p<0.001) and closure of the macular hole (...
Outcomes of Eyes with Failed Primary Surgery for Idiopathic Macular Hole
Ophthalmology Retina, 2018
Purpose: To describe the anatomic and visual outcomes of eyes undergoing reoperation after failed primary surgery for idiopathic macular hole. Design: Prospective registry study. Participants: One hundred three patients who had undergone failed macular hole surgery. Methods: Unclosed idiopathic macular holes were identified from a large national prospective registry run by the Australian and New Zealand Society of Retinal Specialists. Unclosed idiopathic macular holes were defined as idiopathic macular holes that underwent vitrectomy surgery for the first time, but were never observed to close in the postoperative period. Surgeons were contacted to submit retrospectively details of subsequent management and long-term outcome of these eyes. Main Outcome Measures: Macular hole closure; visual acuity (VA) change relative to baseline at 3, 12, and 24 months; and hole size at all time points. Results: One hundred three patients with failed macular hole surgery were identified, among whom 53 underwent reoperation, 49 did not, and 1 was lost to follow-up. Macular hole closure was achieved in 45 of 53 patients (85%) undergoing revision surgery. Mean change in VA from baseline in eyes undergoing revision surgery versus eyes that did not was þ2.8 letters versus À1.9 letters at 3 months (P ¼ 0.278), þ8.2 letters versus À1.9 letters at 12 months (P ¼ 0.167), and þ18.3 letters versus À3.4 letters at 24 months (P ¼ 0.022). Thirty-six percent of eyes with reoperated holes showed improved VA of 15 letters or more at 3 months after operation, increasing to 48% at 12 months and 65% at 2 years. Before revision surgery, mean macular hole size was observed to increase from 483 mm to 562 mm after failed primary surgery (P ¼ 0.046). Conclusions: In eyes undergoing revision surgery, reoperation for unclosed macular holes was significantly better than observation, although these visual gains took some time to occur. The surgical success rate was lower than that for primary idiopathic macular hole. The selection criteria for revision surgery need to be defined. Ophthalmology Retina 2017;-:1e8 ª 2017 by the American Academy of Ophthalmology Supplemental material available at www.ophthalmologyretina.org.
Long-term Outcome of Idiopathic Macular Hole Surgery
American Journal of Ophthalmology, 2010
PURPOSE: To evaluate the role of preoperative macular hole (MH) diameter, cataract surgery, and cystoid macular edema (CME) in the reopening of idiopathic macular hole (IMH) after initially successful surgery.
Study of Anatomical and Visual Outcomes after Macular Hole Surgery
IOSR Journals , 2019
Macular hole management is one of the most challenging clinical retinal disorders in Ophthalmology with varying percentages of anatomical and visual success rates. We herewith report our clinical experience of managing idiopathic and nonidiopathic types of macular holes through this article with comparable success rates.
American Journal of Ophthalmology, 2003
To investigate the anatomic and visual outcomes in patients with initial anatomic success after macular hole surgery and with at least 5 years of follow-up. Retrospective, noncomparative, consecutive case series. Medical records of all patients who underwent surgery for idiopathic full-thickness macular holes by two surgeons (W.E.S., H.W.F.) at the Bascom Palmer Eye Institute between January 1, 1991, and December 31, 1996, were reviewed. All patients who had initial anatomic success with macular hole surgery and who had 5 years or more of follow-up postoperatively were included in the study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes. Seventy-four eyes of 66 patients with a median age of 68.0 years (range, 45.0-86.8 years) were identified. The median duration of macular hole was 6.0 months (range, 1.1-93.8 months), and the median duration of follow-up after macular hole surgery was 91.0 months (range, 60.0 to 114.8 months). The hole reopened in 9 eyes (12%) during the follow-up interval; 6 of these eyes underwent reoperation, and the hole closed in 4 of 6 (67%). Preoperative visual acuity ranged from 20/50 to 20/400 (mean, 20/129; median, 20/100). In the 62 eyes that underwent cataract extraction (CE) after macular hole surgery, CE was performed at a median of 13.9 months after macular hole surgery. Patients achieved their best postoperative visual acuity at a median of 28.5 months after macular hole surgery. Best postoperative visual acuity ranged from 20/20 to 20/400 (mean, 20/36; median, 20/30). Visual acuity at last follow-up ranged from 20/25 to counting fingers (mean, 20/56; median, 20/40). At last follow-up, 43 eyes (58%) had a visual acuity of 20/40 or better, and 57 (77%) had an improvement in visual acuity of 3 or more Snellen lines compared with their preoperative acuity. Macular hole closure and visual acuity improvement after initially successful macular hole surgery persist at follow-up of 5 years and longer in the majority of patients; delayed visual acuity improvement is not attributable to cataract surgery alone.
Ophthalmology Retina, 2018
Purpose: To present the visual and safety outcomes of surgery for primary idiopathic macular holes including predictors of visual acuity and the impact of combined phacovitrectomy surgery. Design: Registry-style, prospective, nonrandomized, observational cohort study. Participants: Patients with idiopathic macular holes undergoing primary surgery. Methods: Surgeons were invited to submit clinical details of all macular hole cases receiving surgery. Baseline demographic and clinical information, and details of surgical intervention were collected. Primary followup data were collected at 3 months postoperatively or before revision surgery, and surgeons were also asked to submit data at 12 and 24 months postoperatively. Main Outcome Measures: Visual acuity improvement !15 letters and !0 letters, change in mean visual acuity, visual acuity !70 letters (20/40), retinal detachment, and endophthalmitis. Results: A total of 2455 eyes of 2366 patients were included in the study, and hole closure was achieved in 95.6% of eyes with a single procedure. Mean baseline vision was 48.3 letters. The proportion of successful eyes improving !15 letters at 3, 12, and 24 months was 59.1%, 69.4%, and 68.2%, respectively. The mean improvement in acuity at 3, 12, and 24 months was 16.0, 19.2, and 23.6 letters, and 92.4%, 93.4%, and 95.8% improved !0 letters at 3, 12, and 24 months, respectively. Eyes receiving SF6 gas had better visual acuities at all time points postoperatively (adjusted effect 3.4, 3.1, and 4.6 letters better at 3, 12, and 24 months vs. longeracting gas, respectively). Combined phacovitrectomy in phakic eyes was associated with better corrected visual acuity postoperatively (vs. vitrectomy surgery alone), a difference that vanished when eyes went on to have subsequent cataract surgery. The rate of retinal detachment postoperatively was 1.3%, and the odds of detachment were greater in eyes receiving longer-acting gases versus SF6 gas (adjusted odds ratio, 2.2; 95% confidence interval, 1.04e4.77; P ¼ 0.039). There were no reported cases of endophthalmitis. Conclusions: Macular hole surgery substantially improved acuity in approximately two thirds of patients and was seldom associated with loss of vision. SF6 gas was associated with better visual outcomes, an effect that warrants further study. Ophthalmology Retina 2018;-:1e9 ª 2018 by the American Academy of Ophthalmology Supplemental material available at www.ophthalmologyretina.org.
Timing and Outcome of Surgery for Persistent Macular Hole
Retina (Philadelphia, Pa.), 2017
To evaluate the efficacy and optimum timing for resurgery in case of persistent macular hole (MH). Twenty-five eyes of 25 patients who underwent fluid-air exchange with intravitreal C3F8 for persistent MH after vitrectomy + internal limiting membrane peeling + SF6 were included in the study. Best-corrected visual acuity, optical coherence tomography features including base diameter and configuration of MH, and time duration between the two surgeries were noted. Patients who underwent resurgery within 3 months of the first surgery had better anatomical closure rate compared with those who underwent resurgery after 3 months (P < 0.05). Significant improvement was seen in best-corrected visual acuity in eyes with closed MH. Eyes having MH with irregular edges on optical coherence tomography had better anatomical closure rates compared with the eyes having MH with round edges. Patients undergoing repeat gas injection within 3 months of the primary surgery for persistent MH have bette...
Re-operation of idiopathic macular hole after failed initial surgery
Biomedical Papers, 2013
Background. Persistent idiopathic macular hole (IMH) after initial pars plana vitrectomy (PPV) appears in approx. 12% of cases. It is, therefore, one of the most common complications. IMH re-operation results tend to be better in eyes where IMH had been closed, while IMH re-operations in cases when the initial surgery had failed tend to be less successful: IMH often becomes even larger and visual acuity decreases, anatomical success rate of closure is about 60% and the resulting postoperative visual acuity is about 20/100. Aims. To establish anatomical and functional success rate of repeated operations of recurrent idiopathic macular hole. Materials and Methods. We evaluated the retrospective results of re-operations of persisting IMH that is cases in which the initial surgery did not result in closure: 6 eyes in 6 patients out of the overall 55 operated on IMH (primary PPV failed in almost 11% of cases). The follow-up period was 18 months (since the first surgery).