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  • Anatomic Failure of MH Surgery Is Common in Blacks

    By Lynda Seminara
    Selected by Prem S. Subramanian, MD, PhD
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    Journal Highlights

    Graefe’s Archive for Clinical and Experimental Ophthalmology
    Published online Jan. 5, 2023

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    Laviers et al. explored the relationship between race and outcomes of macular hole (MH) surgery. They found that the rate of anatomic failure was signifi­cantly higher for Black patients than in those from other racial groups.

    The study was conducted retro­spectively at five hospitals of the U.K. National Health Service and included patients with documented ethnicity who underwent vitrectomy, internal limiting membrane peel, and gas/oil tamponade for any stage of primary full-thickness macular hole (FTMH). The main outcome measure was anatomic success, defined as FTMH closure in one operation. Hole closure was determined by spectral-domain OCT and defined as the absence of any full-thickness foveal neurosensory reti­nal defect. The key secondary outcome was change in BCVA from baseline (pre-op status).

    Overall, 334 operations for MH were performed. Of these, 78.7% took place in White patients, 11.7% in Black patients, 8.1% in Asian patients, and 1.5% in patients of mixed or other race. The mean age of the study population was 69.7 years, and 68.5% were women. Anatomic success was achieved in 280 (83.8%). Anatomic failure occurred in 38.5% of Black patients and 12.6% of White patients (relative risk, 1.788; p = .045). For Asians, the rate of anatomic failure was 18.5%. In regard to BCVA, baseline logMAR improved by a mean of .35 in White patients, .37 in Black patients, .23 in Asian patients, and .38 in those of mixed or other race (p = .689). Greater minimum linear diame­ter boosted the risk of anatomic failure (relative risk, 1.004; p < .0001), whereas better pre-op BCVA and anatomic suc­cess (both p < .0001) conferred greater BCVA improvement.

    Although this research indicates that the rate of anatomic failure after FTMH surgery is much higher for Black patients, the reasons for this are unclear, said the authors. They did find that socioeconomic status did not appear to be related and recommend further investigations to understand the vast racial differences in anatomic outcomes.

    The original article can be found here.