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  • Is It Time to Reclassify Large Macular Holes?

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, November 2018

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    In the Manchester Large Macular Hole Study, Ch’ng et al. looked at anatomic and functional outcomes after vitrectomy for large full-thickness macular holes (FTMH). They found that stan­dard treatment for FTMH is adequate for most holes under 650 μm in diam­eter.

    This retrospective interventional study included 258 eyes with idiopathic large FTMH (diameter >400 μm) treat­ed during a 5-year period. All eyes un­derwent pars plana vitrectomy (PPV), internal limiting membrane (ILM) peel, gas tamponade, and face-down posturing. The face-down position was maintained for 1-5 days. Anatomic and functional success rates were measured, as was the relationship between the size of the macular holes and their closure.

    Anatomic closure was achieved in 90% of eyes. Rates of closure were ≥91% for patients with holes <650 μm. This coincides with the currently accepted success standard of ~90%. Among patients with larger FTMH (650 μm to 1,416 μm), the success rate was only 76%. Maximum sensitivity and speci­ficity were obtained at a cutoff diameter of ≤630 μm (76.7% sensitivity, 69.2% specificity), yielding a Youden index of 0.46. By 3 months postoperatively, 57% of eyes had improved ≥0.3 LogMAR units from preoperative status.

    The original article can be found here.