Abstract
Objectives
To reassess the definition of a large macular hole, factors predicting hole closure and post-surgery visual recovery.
Design
Database study of 1483 primary macular hole operations. Eligible operations were primary MH operations treated with a vitrectomy and a gas or air tamponade. Excluded were eyes with a history of retinal detachment, high myopia, previous vitrectomy or trauma.
Results
A higher proportion of operations were performed in eyes from females (71.1%) who were ‘on average’ younger (p < 0.001), with slightly larger holes (p < 0.001) than male patients. Sulfur hexafluoride gas was generally used for smaller holes (p < 0.001). From 1253 operations with a known surgical outcome, successful hole closure was achieved in 1199 (96%) and influenced by smaller holes and complete ILM peeling (p < 0.001), but not post-surgery positioning (p = 0.072). A minimum linear diameter of ~500 μm marked the threshold where the success rate started to decline. From the 1056 successfully closed operations eligible for visual outcome analysis, visual success (defined as visual acuity of 0.30 or better logMAR) was achieved in 488 (46.2%) eyes. At the multivariate level, the factors predicting visual success were better pre-operative VA, smaller hole size, shorter duration of symptoms and the absence of AMD.
Conclusions
Females undergoing primary macular hole surgery tend to be younger and have larger holes than male patients. The definition of a large hole should be changed to around 500 μm, and patients should be operated on early to help achieve a good post-operative VA.
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Acknowledgements
It is with deep regret that we note the death of our friend and colleague Robert Johnston, who sadly died in September 2016. Without his inspirational vision, determination and career long commitment to quality improvement in ophthalmology this work would not have been possible.
Funding
The database set up and running has been made possible by funding support from the British and Eire Association of Vitreo-retinal Surgeons, and Euretina.
Members of the BEAVRS Macular hole outcome group
Abdallah A. Ellabban7, Andrew H. C. Morris8, Ashraf Khan9, Atiq R. Babar10, Craig Goldsmith11, Deepak Vayalambrone12, Diego Sanchez-Chicharro13, Ed Hughes14, George Turner15, Huw Jenkins16, Imran J. Khan17, Izabela Mitrut18, Jonathan Smith1, Kamaljit S. Balaggan19, Kurt Spiteri Cornish20, Laura Wakeley21, Luke Membrey22, Mark Costen10, E. N. Herbert22, Assad Jalil15, Sandro di Simplicio23, Sonali Tarafdar24, Timothy Cochrane21, Tsveta Ivanova15, Vaughan Tanner25
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DS has received fees as a consultant for Alcon, Orbit Biomedical and Novartis, and research funding from Alcon and Bayer. TW has received consultancy, author or lecturing fees from or has a financial relationship with Valeant Bausch and Lomb, Kingston upon Thames, UK, Alcon Laboratories, Camberley, UK, Oxular Biotech, Oxford, UK, Galecto Biotech, Copenhagen, Denmark, Axsys Technologies, Glasgow, UK, Springer Publishers, Berlin, Germany, CRC Press, Boca Raton, Florida, USA and Daybreak Medical, London, UK. AL, DY, PD and GA declare no conflicts of interest
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Members of the BEAVRS Macular hole outcome group are listed below Acknowledgements
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Steel, D.H., Donachie, P.H.J., Aylward, G.W. et al. Factors affecting anatomical and visual outcome after macular hole surgery: findings from a large prospective UK cohort. Eye 35, 316–325 (2021). https://doi.org/10.1038/s41433-020-0844-x
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DOI: https://doi.org/10.1038/s41433-020-0844-x
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