Original article
Long-term Anatomic and Visual Outcomes of Initially Closed Macular Holes

https://doi.org/10.1016/j.ajo.2010.11.006Get rights and content

Purpose

To evaluate the anatomic and visual outcomes in patients with initially closed macular holes after vitreoretinal surgery and with 1 to 7 years of follow-up.

Design

Retrospective, noncomparative, consecutive case series.

Methods

Eighty-seven consecutive eyes of 79 patients with previous closure of the macular holes and with at least 1 year of follow-up were reviewed in this retrospective clinical study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes.

Results

The mean age of enrolled patients was 63.1 ± 6.2 years (range, 49 to 74 years); the mean duration of macular hole was 5.6 ± 9.7 months (range, 0.25 to 60 months); and the mean follow-up interval was 38.4 ± 19.7 months (range, 12 to 86 months). All eyes underwent internal limiting membrane peeling during the vitrectomy, and 64 (73.6%) of 87 eyes underwent cataract extraction. No reopening of initially closed macular holes was observed in any eyes. Slight perifoveal epiretinal membranes were observed by optical coherence tomography in 32.2% of cases (28/87). The final best-corrected visual acuity improved to 0.47 ± 0.39 logarithm of the minimal angle of resolution units, which was significantly higher than preoperative visual acuity of 1.01 ± 0.36 logarithm of the minimal angle of resolution units (t = −12.532; P = .000). Multiple linear regression analysis demonstrated that the final best-corrected visual acuity was affected by the macular hole stage, preoperative best-corrected visual acuity, and cataract exaction (F = 19.858; P = .000).

Conclusions

The stable closure of macular holes is achieved after vitrectomy with internal limiting membrane peeling. Phacoemulsification cataract surgery with intraocular lens implantation for improvement of visual function is not responsible for the reopening of previously closed macular holes.

Section snippets

Methods

Eighty-seven consecutive eyes of 79 patients who had anatomically successful macular hole surgery were recruited in this retrospective clinical review from January 2003 through April 2009 at the Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, China. The diagnosis of a macular hole was made by the presence of a full-thickness neurosensory defect confirmed by optical coherence tomography (OCT). Macular hole closure was defined as the reattachment of the edge of the hole to the

Results

Eighty-seven eyes (81 phakic eyes and 6 pseudophakic eyes) after anatomic success with macular hole surgery and with 1 to 7 years of postoperative follow-up information were investigated. There were 16 males and 63 females among the 79 patients. The mean age at the first macular hole was 63.1 ± 6.2 years (range, 49 to 74 years). The mean follow-up interval was 38.4 ± 19.7 months (range, 12 to 86 months). The duration of the IMH, which was estimated from the patient's history of visual symptoms,

Discussion

In previous publications on the treatment of IMH with vitrectomy, the reopening rate of the previously closed macular hole varied from 0% to more than 20%.5, 6, 7, 11, 12, 14, 17 In addition to relieving vitreous traction, several intraoperative modifications have been tested in an attempt to enhance closure rates and prevent postoperative reopening. These include the choice of intravitreal tamponade (air, long-acting gases, silicone); the duration of face-down positioning; the use of

Qianli Meng, MD, PhD, is currently an assistant researcher of ophthalmology at Guangdong Eye Institute of Guangdong Academy of Medical Sciences, Guangzhou, China. She received her PhD from the Sun Yat-sen University of Guangzhou, China in 2006. Dr. Meng is especially interested in immunological diseases of the eye, with an emphasis on pathogenesis, diagnostic procedures and clinical management of uveitis. Moreover, her areas of research also include cataract and vitreoretinal diseases.

References (26)

  • A.P. Da Mata et al.

    Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair

    Ophthalmology

    (2001)
  • N.E. Kelly et al.

    Vitreous surgery for idiopathic macular holesResults of a pilot study

    Arch Ophthalmol

    (1991)
  • U.C. Christensen et al.

    Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial

    Br J Ophthalmol

    (2009)
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      The reestablishment of EZ and ELM integrity was associated with better postoperative BCVA. Most studies have evaluated visual improvement for approximately 1 year, whereas 3 have reported results to approximately 5 years after MHS.11,12,14 Leonard et al11 reported continued BCVA improvement from 20/125 before surgery to 20/50 at 12 months and 20/30 at 36 months after surgery.

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    Qianli Meng, MD, PhD, is currently an assistant researcher of ophthalmology at Guangdong Eye Institute of Guangdong Academy of Medical Sciences, Guangzhou, China. She received her PhD from the Sun Yat-sen University of Guangzhou, China in 2006. Dr. Meng is especially interested in immunological diseases of the eye, with an emphasis on pathogenesis, diagnostic procedures and clinical management of uveitis. Moreover, her areas of research also include cataract and vitreoretinal diseases.

    Shaochong Zhang, MD, is a professor of ophthalmology at the Zhongshan Ophthalmic Center of the Sun Yat-sen University, Guangzhou, China. He obtained his MD from the Sun Yat-sen University of Medical Sciences of Guangzhou, China in 1990. Prof. Zhang's research is focused on the diagnosis and treatment of vitreoretinal diseases, including the surgical management of macular holes, retinal detachment, diabetic retinopathy, and age-related macular degeneration. He is a member of the Chinese Ophthalmological Society.

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