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Preop macular hole diameter associated with surgical success
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FORT LAUDERDALE, Fla. — Preoperative visual acuity and macular hole size correlated strongly with anatomic outcomes from surgical intervention, according to a poster presented here.
Adrea Benkoff, MD, and colleagues reported study results at the Association for Research in Vision and Ophthalmology meeting.
"An excellent surgical prognosis exists for [macular holes] with mid-hole diameter less than 500 µm and base hole less than 1,000 µm," the authors reported. "Our study suggests success rates of approximately 85% for macular holes with mid-hole diameter 500 µm or more and 80% for macular holes with base-hole 1,000 µm or more."
The retrospective, interventional case series included 153 eyes that underwent 25-gauge pars plana vitrectomy for idiopathic stage 3 or stage 4 full-thickness macular hole. Surgical success was based on optical coherence tomography assessment of hole closure at 3 months postop.
Study data showed anatomic success in 143 eyes (93.5%) and failure in 10 eyes (6.5%). Eyes with surgical success had a mean duration from diagnosis to surgery of 16.2 weeks. Eyes with surgical failure had a mean interval to surgery of 27.8 weeks. The difference was not statistically significant.
Mean preop logMAR visual acuity was 0.94 for eyes with success and 1.30 for eyes that failed.
Results showed no failures among 86 eyes with mid-hole diameter of less than 500 µm and 10 failures among 67 eyes with mid-hole diameter more than 500 µm. Data showed no failures among 34 eyes with base hole diameter of less than 500 µm and one failure among 72 eyes with base hole diameter of 500 µm to 999 µm.
This is an interesting study that evaluated preoperative characteristics of a cohort of patients with macular hole. The authors conclude that of all factors evaluated, preoperative macular hole diameter was most predictive for postoperative macular hole closure.
This is an interesting finding because it is helpful to be able to predict the likelihood of surgical success, particularly given the fact that many surgeons instruct patients to undergo postoperative face-down positioning.
One beneficial aspect of these findings is that OCT was a strong predictor, and OCT is a quantitative and reproducible test. OCT should likely be performed in all patients who present with macular hole, both to diagnose the condition and to apply the results of this study to the preoperative discussion. Notably, the results of this study support the previous literature concerning this topic (Ip MS, Baker BJ, Duker JS, et al. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography. Arch Ophthalmol. 2002;120(1):29-35).
– Michael S. Ip, MD
Associate professor,
University of Wisconsin, Madison
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