Abstract
Purpose: The study aims to determine the anatomical success and functional outcome of pars plana vitrectomy (PPV) for macular holes (MH) performed at a single study center using a consistent procedure of internal limiting membrane (ILM) peeling, SF6 tamponade and 3 days face-down positioning. Methods: A retrospective cross-sectional study involving eyes with MHs which underwent 23- or 25-gauge PPV with or without phacoemulsification and all undergoing a 20% SF6 gas tamponade, follow-up to 6 months postoperatively were included at the Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway (12-month study period between 1 January and 31 December 2015) Pre- and post-operative Best-Corrected Visual Acuity (BCVA) assessment, comprehensive eye examination and intraocular pressure (IOP) measurement. as well as Optical Coherence Tomography to determine the diameter of the MH and its closure were all carried out. Results: 198 consecutive eyes operated for MH (age: 69.4 ± 7.6 years; 1.6:1 female:male ratio) were included; 35.7%/48.6% had symptoms from 3–6/6–48 months; 5.1% had high-grade myopia, 21.5% focal VMT <1500 µm with or without epiretinal membrane (ERM), and 74.0%/26.0% had phakic/pseudophakic status. Primary closure of the MH occurred in 93.3% of the patients. Lens status and length of symptoms showed no significant correlation with closure of the MH. The pre-operative logMAR visual acuity: 0.8 ± 0.3 (median: 0.7; interquartile range (IQR): 0.5–0.8; range: 0.3–1.7), improved significantly post-operatively: 0.4 ± 0.3 (median: 0.3; interquartile range (IQR): 0.1–0.5; range: −0.02–1.2). BCVA improvement of <0.2, 0.2–0.4 and >0.4 was present in 28.3%, 27.3% and 44.4% of the treated patients. No significant median differences could be detected between the duration of the pre-operative symptoms and the pre-/post-operative visual acuity. Increased IOP was measured in 2.6% of the cases day after surgery. Conclusions: Our study found visual outcome not to be dependent upon the length of symptoms in MH patients treated by PPV all undergoing ILM peeling, SF6 tamponade and face-down positioning. The large diameter MH was not a limiting factor to achieve improved post-operative BCVA.
Highlights
The disorders of the vitreo-macular interface (VMI) are relatively common and cause symptoms of metamorphopsia, decreased quality of life and significant loss of vision [1,2]
A retrospective cross-sectional study involving eyes with macular holes (MH) which underwent 23- or 25-gauge pars plana vitrectomy (PPV) with or without phacoemulsification and all undergoing a 20% SF6 gas tamponade, follow-up to 6 months postoperatively were included at the Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway (12-month study period between 1 January and 31 December 2015) Pre- and post-operative Best-Corrected Visual Acuity (BCVA) assessment, comprehensive eye examination and intraocular pressure (IOP) measurement. as well as Optical Coherence Tomography to determine the diameter of the MH and its closure were all carried out
198 consecutive eyes operated for MH were included; 35.7%/48.6% had symptoms from 3–6/6–48 months; 5.1% had high-grade myopia, 21.5% focal vitreomacular tractions (VMTs)
Summary
The disorders of the vitreo-macular interface (VMI) are relatively common and cause symptoms of metamorphopsia, decreased quality of life and significant loss of vision [1,2]. Is a VMI disorder which requires, for most of the cases, an elective vitrectomy [3,4]. The outcome of such surgery depends on the pre-operative visual acuity, duration and size/stage of the hole, presence and grade of myopia, as well as other comorbidities [5,6,7,8,9,10]. MH surgery, improves the pre-to-post-operative visual acuity. Another measurable outcome for successful MH surgery is closure of the hole, which is rather an anatomical and not functional outcome of the surgery. MH can occasionally close on their own
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