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  • Long-Term Outcomes for Idiopathic Macular Holes

    By Jean Shaw
    Selected By: Andrew P. Schachat, MD

    Journal Highlights

    Ophthalmology Retina, April 2020

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    Elhusseiny et al. set out to evaluate long-term structural and visual outcomes in patients who underwent pars plana vitrectomy (PPV) for idiopathic full-thickness macular hole (MH). They found that visual acuity continued to improve at least three years after PPV and was maintained thereafter in a sub­stantial percentage of the patients.

    This retrospective case series involved 80 patients (87 eyes) who underwent PPV for idiopathic MH and had follow-up of at least five years’ duration. The mean postoperative follow-up was 9.6 ± 4.3 years (median, 9 years; range, 5-22 years). Only cases of idiopathic MH were included in this case analysis; patients with traumatic, recurrent, persistent, and secondary MHs were excluded. The main outcome measure was postoperative best-corrected visual acuity (BCVA) and its correla­tion with different parameters evident on spectral-domain optical coherence tomography (SD-OCT).

    Initial successful MH closure was achieved in 82 eyes (94%). Seven eyes (8%) experienced MH reopening and underwent reoperation. The mean BCVA for the entire cohort improved from 0.20 ± 0.13 before surgery to 0.39 ± 0.23 at one year, 0.43 ± 0.26 at two years, 0.47 ± 0.29 at three years, and 0.50 ± 0.26 at five years. In addition, for patients with longer follow-up, BCVA was 0.53 ± 0.28 at eight years and 0.61 ± 0.27 at 10 years.

    SD-OCT confirmed that postop­erative integrity of the ellipsoid zone was established in 52 eyes (60%) and external limiting membrane integrity was restored in 54 eyes (62%). Cystoid spaces of variable severity were observed in 28 eyes (32%). Pre-op BCVA of 20/60 or better and post-op ellipsoid zone and external limiting membrane integ­rity were associated with better BCVA at follow-up.

    The original article can be found here.