Predictive Factors of the Anatomical and Functional Success of Macular Hole Surgery
DOI:
https://doi.org/10.48560/rspo.26617Keywords:
Retinal Perforations/diagnosis, Retinal Perforations/epidemiology, Retinal Perforations/surgeryAbstract
Introduction: Idiopathic macular hole (iMH) is a vitreoretinal interface pathology which is treatment is surgical-based. Currently, the anatomical success rate of the surgery varies between 85% and 100%, however, the functional recovery of visual acuity may be limited despite successfully closing the iMH. Our purpose was to identify preoperative factors that better predict the anatomical and functional success of iMH surgery. Methods: Retrospective cohort study of patients submitted to pars plana vitrectomy for iMH treatment aided by peeling of the internal limiting membrane or inverted flap technique, between January 2015 and December 2019, at Hospital de Braga. The following parameters were evaluated: age, sex, best preoperative corrected visual acuity (preBCVA), time spent from diagno- sis to surgery (TTS), iMH size, presence of concomitant epiretinal membrane or adherent posterior hyaloid membrane (PHM) and surgical technique used. The correlation between the described parameters and the anatomical surgical success and the postoperative BCVA (functional success) was evaluated. Results: Seventy-one eyes of 67 patients were included, with female predominance (71.6%) and a mean age of 68.3 ± 8.3 years at diagnosis. Anatomical success was obtained in 70.4% eyes and none of the factors analyzed had a statistically significant impact on the anatomical success of the surgery. On the other hand, it was observed that preBCVA (b = 0.540; t = 5.371; p <0.001), TTS (b = 0.001; t = 2.203; p = 0.031) and adherent PHM (b = -0.258; t = -2.098; p = 0.043) had a significant impact on postoperative BCVA. Multivariate linear regression analysis showed that only preBCVA had an impact in predicting functional recovery (b = 0.381; t = 2.784; p = 0.009). Conclusion: Preoperative visual acuity is the best predictor of the functional success of iMH surgery, suggesting that it allows a better management of patient ́s pre-surgical expectations.Downloads
References
Gass JD. Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol. 1988;106:629-39.
Ezra E. Idiopathic full thickness macular hole: natural history and pathogenesis. Br J Ophthalmol. 2001;85:102-8.
Chen Q, Liu ZX. Idiopathic Macular Hole: A Comprehensive Review of Its Pathogenesis and of Advanced Studies on Metamorphopsia. J Ophthalmol. 2019;2019:7294952. doi: 10.1155/2019/7294952.
Madi HA, Masri I, Steel DH. Optimal management of idiopathic macular holes. Clin Ophthalmol. 2016;10:97-116. doi: 10.2147/OPTH.S96090.
Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991;109:654-9. 6. Kadonosono K, Yabuki K, Nishide T, Uchio E, Marron JA. Measured visual acuity of fellow eyes as a prognostic factor in macular hole surgery. Am J Ophthalmol. 2003;135:493-8.
Vaziri K, Schwartz SG, Kishor KS, Fortun JA, Moshfeghi AA, Smiddy WE, et al. Rates of Reoperation and Retinal Detachment after Macular Hole Surgery. Ophthalmology. 2016;123:26-31. doi: 10.1016/j.ophtha.2015.09.015.
Kim SH, Kim HK, Yang JY, Lee SC, Kim SS. Visual Recovery after Macular Hole Surgery and Related Prognostic Factors. Korean J Ophthalmol. 2018;32:140-6. doi: 10.3341/kjo.2017.0085.
Morizane Y, Shiraga F, Kimura S, Hosokawa M, Shiode Y, Kawata T, et al. Autologous transplantation of the internal limiting membrane for refractory macular holes. Am J Oph- thalmol. 2014;157:861-9.e1. doi: 10.1016/j.ajo.2013.12.028.
Ittarat M, Somkijrungroj T, Chansangpetch S, Pongsachareonnont P. Literature Review of Surgical Treatment in Idiopathic Full-Thickness Macular Hole. Clin Ophthalmol. 2020;14:2171- 83. doi: 10.2147/OPTH.S262877.
Haritoglou C, Neubauer AS, Reiniger IW, Priglinger SG, Gass CA, Kampik A. Long-term functional outcome of macular hole surgery correlated to optical coherence tomography measurements. Clin Exp Ophthalmol. 2007;35:208-13.
Ruiz-Moreno JM, Staicu C, Piñero DP, Montero J, Lugo F, Amat P. Optical coherence tomography predictive factors for macular hole surgery outcome. Br J Ophthalmol. 2008;92:640-4.
Unsal E, Cubuk MO, Ciftci F. Preoperative prognostic factors for macular hole surgery: Which is better? Oman J Ophthalmol. 2019;12:20-4. doi: 10.4103/ojo.OJO_247_2017.
Ip MS, Baker BJ, Duker JS, Reichel E, Baumal CR, Gangnon R, et al. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography. Arch Ophthalmol. 2002;120:29-35.
Ullrich S, Haritoglou C, Gass C, Schaumberger M, Ulbig MW, Kampik A. Macular hole size as a prognostic factor in macular hole surgery. Br J Ophthalmol. 2002;86:390-3.
Hirneiss C, Neubauer AS, Gass CA, Reiniger IW, Priglinger SG, Kampik A, et al. Visual quality of life after macular hole surgery: outcome and predictive factors. Br J Ophthalmol. 2007;91:481-4.
Kusuhara S, Negi A. Predicting visual outcome following surgery for idiopathic macular holes. Ophthalmologica. 2014;231:125-32. doi: 10.1159/000355492.
Bottoni F, De Angelis S, Luccarelli S, Cigada M, Staurenghi G. The dynamic healing process of idiopathic macular holes after surgical repair: a spectral-domain optical coherence tomog- raphy study. Invest Ophthalmol Vis Sci. 2011;52:4439-46. doi: 10.1167/iovs.10-6732.
Bainbridge J, Herbert E, Gregor Z. Macular holes: vitreoretinal relationships and surgical approaches. Eye. 2008;22:1301-9.
Richter-Mueksch S, Sacu S, Osarovsky-Sasin E, Stifter E, Kiss C, Velikay-Parel M. Visual performance 3 years after successful macular hole surgery. Br J Ophthalmol. 2009;93:660-3.
Haritoglou C, Gass CA, Schaumberger M, Ehrt O, Gandorfer A, Kampik A. Macular changes after peeling of the internal limiting membrane in macular hole surgery. Am J Ophthalmol. 2001;132:363-8.
Jaycock PD, Bunce C, Xing W, Thomas D, Poon W, Gazzard G, et al. Outcomes of macular hole surgery: implications for surgical management and clinical governance. Eye. 2005;19:879-84.
Leonard RE, 2nd, Smiddy WE, Flynn HW, Jr., Feuer W. Longterm visual outcomes in patients with successful macular hole surgery. Ophthalmology. 1997;104:1648-52.
Kumagai K, Furukawa M, Ogino N, Uemura A, Demizu S, Larson E. Vitreous surgery with and without internal limiting membrane peeling for macular hole repair. Retina. 2004;24:721-7.
Larsson J, Holm K, Lövestam-Adrian M. The presence of an operculum verified by optical coherence tomography and other prognostic factors in macular hole surgery. Acta Oph- thalmol Scand. 2006;84:301-4.
Gupta B, Laidlaw DA, Williamson TH, Shah SP, Wong R, Wren S. Predicting visual success in macular hole surgery. Br J Ophthalmol. 2009;93:1488-91.
Ryan EH, Jr., Gilbert HD. Results of surgical treatment of recent-onset full-thickness idiopathic macular holes. Arch Ophthalmol. 1994;112:1545-53.
Kang HK, Chang AA, Beaumont PE. The macular hole: report of an Australian surgical series and meta-analysis of the literature. Clin Exp Ophthalmol. 2000;28:298-308.
Morawski K, Jędrychowska-Jamborska J, Kubicka-Trząska A, Romanowska-Dixon B. The Analysis of spontaneous closure mechanisms and regeneration of retinal layers of a full-thickness macular hole: relationship with Visual Acu- ity Improvement. Retina. 2016;36:2132-9. doi: 10.1097/ IAE.0000000000001074.
Wakely L, Rahman R, Stephenson J. A comparison of several methods of macular hole measurement using optical coherence tomography, and their value in predicting anatomical and visual outcomes. Br J Ophthalmol. 2012;96:1003-7.
Shpak AA, Shkvorchenko DO, Sharafetdinov I, Yukhanova OA. Predicting anatomical results of surgical treatment of idiopathic macular hole. Int J Ophthalmol. 2016;9(2):253-7.
Guyer DR, Green WR, de Bustros S, Fine SL. Histopathologic features of idiopathic macular holes and cysts. Ophthalmology. 1990;97:1045-51.
Cheng L, Azen SP, El-Bradey MH, Toyoguchi M, Chaidhawangul S, Rivero ME, et al. Effects of preoperative and postoperative epiretinal membranes on macular hole closure and visual restoration. Ophthalmology. 2002;109:1514-20.
Wendel RT, Patel AC, Kelly NE, Salzano TC, Wells JW, Novack GD. Vitreous surgery for macular holes. Ophthalmology. 1993;100:1671-6.
Liesenhoff O, Messmer EM, Pulur A, Kampik A. Surgical management of complete macular foramina. Ophthalmologe. 1996;93:655-9.
Freeman WR, Azen SP, Kim JW, el-Haig W, Mishell DR, 3rd, Bailey I. Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Results of a multicentered randomized clinical trial. The Vitrectomy for Treatment of Macular Hole Study Group. Arch Ophthalmol. 1997;115:11-21.
Brooks HL, Jr. Macular hole surgery with and without internal limiting membrane peeling. Ophthalmology. 2000;107:1939-48; discussion 48-9.
Margherio RR, Margherio AR, Williams GA, Chow DR, Banach MJ. Effect of perifoveal tissue dissection in the management of acute idiopathic full-thickness macular holes. Arch Ophthalmol. 2000;118:495-8.
Johnson MW., Posterior vitreous detachment: evolution and complications of its early stages. Am J Ophthalmol. 2010;149:371-82.e1.
Chen G, Tzekov R, Jiang F, Mao S, Tong Y, Li W. Inverted ILM flap technique versus conventional ILM peeling for idiopathic large macular holes: A meta-analysis of randomized controlled trials. PLoS One. 2020;15:e0236431. doi: 10.1371/ journal.pone.0236431.
Yu JG, Wang J, Xiang Y. Inverted Internal Limiting Membrane Flap Technique versus Internal Limiting Membrane Peeling for Large Macular Holes: A Meta-Analysis of Randomized Controlled Trials. Ophthalmic Res. 2021;64:713-22. doi: 10.1159/000515283.
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