Abstract
BackgroundTo assess the effectiveness and safety of 23-gauge pars plana vitrectomy combined with phacoemulsification versus vitrectomy alone in patients over 50 years with primary full-thickness macular holes (FTMH).MethodsWe retrospectively reviewed the medical records related to 406 consecutive vitrectomies performed for primary FTMH. Phacovitrectomy was performed in 294 phakic eyes whereas vitrectomy alone in 112 pseudophakic eyes. The cases were divided into three groups according to the stage of the FTMH: stage 2 (n = 93), stage 3 (n = 270), or stage 4 (n = 43). The primary outcome measure was the closure of the FTMH. The secondary outcome measures were the evolution of visual acuity as well as intraoperative and postoperative complications.ResultsNeither the primary nor the secondary outcomes differed between phacovitrectomy and vitrectomy alone for all three stages. The FTMH were closed in 375 eyes (92.4 %) after a first operation. The closure rate was higher for stage 2 (96.8 %) than for stages 3 (91.1 %) or 4 (90.75 %), but not significantly (P = 0.189). The mean visual acuity increased significantly from preoperatively LogMAR 0.68 (± SD 0.2) to LogMAR 0.43 (± SD 0.24) at the end of the follow-up (p < 0.001).ConclusionsCombined 23-gauge pars plana vitrectomy with phacoemulsification for primary FTMH repair in patients over 50 years is as efficient and safe when compared with vitrectomy only.Trial registrationThe study was approved on 30th April 2020 by the local ethics committee (Ethikkommission Ostschweiz, EKOS 20/074; BASEC Nr. 2020-01033).
Highlights
To assess the effectiveness and safety of 23-gauge pars plana vitrectomy combined with phacoemulsification versus vitrectomy alone in patients over 50 years with primary full-thickness macular holes (FTMH)
The aperture size of the FTMH was measured at the narrowest hole width using the caliper function of the optical coherence tomography (OCT) device as a line drawn approximately parallel to the retinal pigment epithelium [23]
The patients with pseudophakic eyes were older in the vitrectomy alone group which was significant for the women with stages 2, or 3 macular holes (P < 0.001), and for the men with stage 3 macular holes (P = 0.007)
Summary
To assess the effectiveness and safety of 23-gauge pars plana vitrectomy combined with phacoemulsification versus vitrectomy alone in patients over 50 years with primary full-thickness macular holes (FTMH). Full-thickness macular hole (FTMH) is defined as a foveal lesion with interruption of all retinal layers from the internal limiting membrane to the retinal pigment epithelium [1]. Tangential or perpendicular traction to Valmaggia et al BMC Ophthalmology (2021) 21:174 is diagnosed in 86 to 92 % of cases [4]. The reported prevalence is 0.02–0.8 %, with 7.8 new cases per 100’000 population per year [5]. The female predominance in primary FTMH is explained by the postmenopausal drop in the estrogen levels, leading to increased vitreous liquefaction, and a higher likelihood for FTMH [6]
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