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  • Longer duration of macular hole symptoms may correlate with poorer repair outcomes

    Retina/Vitreous

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    Review of: The effect of macular hole duration on surgical outcomes: An individual participant data study of randomized controlled trials

    Murphy D, Al-Zubaidy M, Lois N, et al. Ophthalmology, February 2023

    A meta-analysis of patients who underwent repair for full-thickness macular holes suggests that worse visual and anatomic outcomes can be expected the longer a patient experiences macular hole symptoms before surgery.

    Study design

    This systemic review analyzed randomized controlled trials (RCTs) of adults with idiopathic full-thickness macular holes (iFTMH) who underwent repair and for which symptom duration, pre- and postoperative best-corrected visual acuity (BCVA), and the dimensions of the iFTMH were recorded. The goal was to investigate the effect of symptom duration on both primary anatomic closure and BCVA at 6 months postoperatively. Data was obtained from 12 RCTS for a total of 940 eyes.

    Outcomes

    A positive correlation between macular hole size and symptom duration was demonstrated. In addition, larger holes were associated with a lower baseline BCVA. Postoperative iFTMH closure was achieved in 81.5% of eyes; patients who achieved primary closure reported a 6-month median duration of symptoms, and those who failed primary closure reported a 9-month median duration of symptoms. Improved final BCVA was associated with the intraoperative use of internal limiting membrane flaps, long-acting tamponade, smaller hole size, better preoperative BCVA, and phakic status.

    Limitations

    The purpose of this study was to analyze the effect of symptom duration on macular hole repair outcomes, yet it included RCTs with differing primary endpoints. Additionally, there was no common protocol for defining symptom duration. Most importantly, a patient’s perspective on the length of time of blurred vision does not always correlate with the true timing of pathology.

    Clinical significance

    This meta-analysis suggests that longer symptom duration before iFTMH repair is independently associated with poorer anatomic and visual outcomes. This emphasizes the need to refer these patients to a retina specialist in an expeditious manner and ensure that surgical scheduling is prompt.

    Financial Disclosures: Dr. Lisa Schocket discloses no financial relationships.