Author/Authors :
Parolini, Barbara Istituto Clinico S.Anna di Brescia, Italy , Michalewska, Zofia Ophthalmic Clinic "Jasne Blonia", Rojna, Poland , Hardin, Joshua S Jones Eye Institute - University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA , Ducournau, Didier Clinique Sourdille, Nantes, France , Othman, Ihab Saad Ophthalmology Department - Cairo University, Egypt , Faramawi, Mohammed F. Epidemiology Department - College of Public Health and Biomedical informatics, College of Medicine - University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA , Adelman, Ron A. Ophthalmology Department - Yale University School of Medicine, New Haven, CT, USA , Sallam, Ahmed B. Jones Eye Institute - University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
Abstract :
Background: To identify prognostic preoperative and intraoperative factors for anatomical and visual success of idiopathic macular hole (MH) surgery. Methods: We conducted a non-randomized, collaborative multicenter study using data of 4207 MH surgery from 140 surgeons. Main study outcomes were anatomical closure and best corrected visual acuity (BCVA) improvement postoperative at 6-12 months. Results: Information on anatomical success was available for 4138 eyes of 4207 operations. Anatomical closure of MH was achieved in 85.7% (3546 eyes). Closure was higher in smaller MH (stages 1-2 versus stage 3: OR=0.35; stage 2 versus stage 4: OR=0.16, and in MH with shorter duration before the operation (OR=0.94). Macular Holes were more likely to close when dyes were used to facilitate internal limiting membrane (ILM) peeling (odds ratio=1.73 to 3.58). The most important predictors of postoperative BCVA were the preoperative BCVA (estimate=0.39, p<0.001) and closure of the macular hole (estimate=0.34, p<0.001). We observed Larger improvement in BCVA in combined vitrectomy and phacoemulsification (estimate = 0.10) and post cataract surgery in phakic eyes (estimate=0.05). Retinal tears occurred in 5.1% of eyes, and were less with use of trocars (OR= -1.246) and in combined vitrectomy/ phacoemulsification surgery (OR= -0.688). Conclusion: This international survey confirmed that staining with dyes improves anatomical results but not visual outcomes. After surgery, visual acuity improved during the first year, and final visual acuity was better in both pseudophakic eyes and eyes that underwent cataract surgery during the first year following MH repair.
Keywords :
Macular Hole , Vitrectomy , Inverted ILM Flap , Full-Thickness Macular Hole , ILM Peeling , Complete Vitrectomy , Combined Surgery , Positioning , Internal Limiting Membrane
