Functional outcomes of idiopathic macular hole surgeries

Abstract

To study the dynamics of visual status and its correlation with morphological changes in patients operated for idiopathic macular hole (IMH). The study enrolled 78 patients (82 eyes) whose ocular media remained transparent throughout the whole follow-up period that started 1 month after a successful IMH surgery and lasted for no less than a year. Two equivalent subgroups, 29 patients (30 eyes) each, were then formed and designated as «transparent media» (pseudophakic patients or those who remained free of cataract over the follow-up period) and «comparison». Only patients from the «transparent media» subgroup have consistently improved their visual functions by the end of the first year after surgery. Positive correlation has been found between an increase in best corrected visual acuity (BCVA) and a decrease in the size of the hyporeflective defect within the so called ellipsoid zone (correlation coefficient r=-0.50, p<0.01). The correlation was the strongest at months 3 and 12 (r=-0.57, p<0.01). It was also noticed that the lower BCVA at baseline the greater the treatment effect (ETDRS chart; r=-0.93, p<0.000). As a result, at the end of the follow-up period, BCVA varied little, reaching 0.5--1.0 in 76 cases and 0.3--0.4 in the remaining 6 cases. Modern IMH surgery ensures restoration of the outer retinal structure and high visual functions in most patients over a long term (more than a year of follow-up) on the only condition of transparent ocular media. Thus, the prediction of postoperative VA is of low significance in these patients.