Topical therapy has no impact on outcomes of later surgical macular hole repair
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Previous unsuccessful topical therapy does not affect outcomes in patients who undergo surgical macular hole repair, according to a study presented at the American Society of Retina Specialists annual meeting.
Gennady Landa, MD, of New York Eye and Ear Infirmary of Mount Sinai, said that the conservative management of macular holes with triple topical therapy is effective for most patients but not all.
“Real-world data indicate that a significant percentage of macular hole patients remain unresponsive to topical medical therapy and eventually require surgical intervention,” he said.
Landa and colleagues sought to determine the visual outcomes of patients who failed topical therapy and eventually had to undergo macular hole repair surgery. The retrospective study only included patients who presented with primary idiopathic full-thickness macular hole and had straightforward surgical cases.
Of the 47 eyes in the analysis, 21 previously underwent unsuccessful treatment with a course of eye drops and eventually underwent macular hole repair surgery, and 26 underwent macular hole repair surgery without previous eye drops.
Eyes in both groups had significantly improved best corrected visual acuity postoperatively. Eyes previously treated with eye drops had better preoperative BCVA and a trend for better postoperative BCVA, Landa said.
Additionally, both groups had a similar percentage of macular hole closure.
Landa said that preoperative BCVA is a known predictive factor for good functional outcomes after macular hole surgery, but that decreases as the size of the macular hole increases.
“Given the smaller dimensions of both minimum linear diameter and basal diameter of macular holes in the eyes that were topically treated before the decision to proceed with the surgery, the better visual outcome could probably indicate that the eyes with the smaller macular holes seemed to be chosen for medical presurgical pretreatment,” he said. “Presurgical trial with eye drops may be safely attempted in selected macular hole patients without the concern of potential surgical delay in case of topical therapy failure.”
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Landa G. Postsurgical visual outcomes in patients with macular hole after unsuccessful topical therapy. Presented at: American Society of Retina Specialists annual meeting; July 17-20, 2024; Stockholm.
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