Patient age is not a major factor for macular hole surgery

Offer surgery to elderly patients with recent onset of macular holes who are symptomatic, study suggests.

Issue: March 1, 2000

ByBob Kronemyer

ORLANDO, Fla. — Macular hole surgery renders no significant differences in anatomic or visual results between patients younger or older than 80 years, according to the results of a retrospective, case control series of idiopathic macular holes.

In addition to a 95% closure rate in patients over 80 years old, “both groups had significant improvement in visual acuity, with a mean gain of 4.3 Snellen lines,” said senior author Raymond N. Sjaarda, MD, a retina specialist in private group practice in Baltimore. Therefore, the authors believe that macular hole surgery should be offered to elderly patients with recent onset of macular holes who are symptomatic.

The study, which was presented here at the American Academy of Ophthalmology (AAO) meeting, involved 20 consecutive eyes in patients over age 80 (average age 83) that were matched to 20 nonconsecutive eyes in patients younger than age 80 (average age 68). “Case control subjects were matched on several preoperative variables,” Dr. Sjaarda said. “Visual acuity was matched to within one Snellen line.” In addition, lens status was matched (except for one aphake that was paired with a pseudophake) and lens clarity was matched to within one grade. “However, duration of macular hole was matched less rigorously, with a mean 7 week difference,” he said.

No statistical differences

The main outcome measures were closure of the macular hole, and visual acuity at 3 months and at final examination (study group mean 1.26 years; control group mean 1.46 years). “There were no statistical differences between the two groups in visual acuity, age of the macular hole or preoperative intraocular pressure,” Dr. Sjaarda said. However, there was a small difference in lens clarity. “Patients over 80 years of age had slightly greater nuclear sclerosis,” he said.

At 3 months, successful hole closure was observed in 95% of patients over the age of 80 and in 85% of patients under the age of 80. “One patient older than 80 and two patients younger than 80 had a second macular hole surgery,” Dr. Sjaarda said. All holes eventually closed.

Likewise, at final exam, there were no statistical differences between macular hole closure rates or visual outcome rates between the two groups: 80% to 85% of patients gained at least two lines and 70% to 80% gained at least three lines. “Visual acuity, change in visual acuity and time to final exam were not statistically different between the two groups,” Dr. Sjaarda said. Overall, visual acuity improved from 20/160 preoperatively to approximately 20/50 to 20/63 postoperatively, representing an improvement in visual acuity of four lines.

Similar complications

Complications also were similar between study and control patients. “Nuclear sclerotic cataracts progressed in most phakic eyes,” Dr. Sjaarda said, noting that preoperatively 35% of patients were aphakic or pseudophakic. Postoperatively, 70% of patients over the age of 80 years were pseudophakic and 60% of patients younger than 80 years were pseudophakic. In addition, there were no cases of retinal detachment, endophthalmitis, phototoxicity or episodes of glaucoma.

“With the information from this study, we are able to counsel octogenarian patients that they have just as much of a chance for a return of vision as a younger patient,” said Neil E. Kelly, MD, who discussed the study at the AAO meeting. Hence, “I agree with the authors’ recommendations that macular hole surgery should be offered to elderly patients with recent onset macular holes if the patient is symptomatic and is willing to have the surgery.”

Dr. Kelly also noted that one would expect more nuclear sclerosis in the study group than in the younger group. “This skewed final visual results because, postoperatively, a similar number was rendered pseudophakic,” he said.

For Your Information:

Raymond N. Sjaarda, MD, can be reached at 6569 N. Charles St., Ste. 504, Baltimore, MD 21204; (410) 296-9700; fax: (410) 296-9705. Dr. Sjaarda has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.

Neil E. Kelly, MD, can be reached at 3939 J St., Ste. 106, Sacramento, CA 95819; (916) 454-4861; fax: (916) 454-3603. Dr. Kelly has no direct financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.