Long-Term Outcomes after Macular Hole Surgery

Abstract

To evaluate the structural and visual outcomes after pars plana vitrectomy (PPV) for idiopathic full-thickness macular hole (MH) with at least 5 years of follow-up information. Retrospective case series. Patients with idiopathic MH who had at least 5 years of follow-up information after PPV. Best-corrected visual acuity (BCVA) was recorded preoperatively and, when available, at 1, 2, 3, 5, 8, and 10 years after surgery. Reestablishment of the postoperative integrity of the ellipsoid zone (EZ) and the external limiting membrane (ELM) and presence of cystoid spaces were evaluated using spectral-domain (SD) OCT. Postoperative BCVA and its correlation with different SD OCT parameters. Eighty-seven eyes of 80 patients with a mean age at surgery of 68.9±7.03 years were included. The mean postoperative follow-up was 9.6±4.3 years (median, 9 years; range, 5-22 years). The mean preoperative BCVA was 0.20±0.14 (range, 0.03-0.66). Postoperative BCVA was improved at all time points compared with preoperative BCVA (P < 0.05). Improvement in the postoperative BCVA remained stable 10 years after surgery. Initial successful closure of MH was achieved in 82 eyes (94%). Macular hole reopening occurred in 7 eyes (8.0%). Eleven eyes (13%) were reoperated: 4 eyes (4.5%) for persistence and 7 eyes (8.0%) for reopening of MH. Indocyanine green (ICG) stain was used in 22 eyes (25.2%). Among 57 patients (66%) who were phakic before surgery, 52 eyes (91.2%) underwent cataract extraction after PPV at a mean duration of 32.7±38.5 months (range, 2-187 months). Postoperative EZ integrity was restored in 52 eyes (60%), ELM integrity was restored in 54 eyes (62%), and cystoid spaces of variable severity were observed in 28 eyes (32%). Preoperative BCVA of 20/60 or better and postoperative reestablished ELM and EZ integrity were associated significantly with better postoperative BCVA at different postoperative follow-up visits (P < 0.05). Visual acuity improvement after MH surgery continued during the first 3 years after PPV and was maintained thereafter in a substantial fraction of patients, and final BCVA correlated with better preoperative BCVA and better postoperative OCT parameters.