The Manchester Large Macular Hole Study: Is it Time to Reclassify Large Macular Holes?
Am J Ophthalmol
; 195: 36-42, 2018 11.
Article
em En
| MEDLINE
| ID: mdl-30071212
ABSTRACT
PURPOSE:
To evaluate anatomic and functional outcomes of full-thickness macular holes (FTMH) larger than 400 µm following vitrectomy, internal limiting membrane peel, gas tamponade, and face-down posturing.DESIGN:
A retrospective interventional case series.METHODS:
A total of 258 consecutive eyes with FTMH larger than 400 µm were enrolled at the Manchester Royal Eye Hospital study over a 5-year period from 2012 to 2017. All eyes underwent pars plana vitrectomy, ILM peel, and gas tamponade. Anatomic success rates were measured. A correlation between macular hole size and closure was evaluated.RESULTS:
A total of 258 eyes were analyzed. The anatomic closure rate was 89.92%. When divided into quartiles, the closure rate of FTMH was 98% (64/65) in the 400-477 µm quartile, 91% (59/65) in the 478-558 µm quartile, 94% (60/64) in the 559-649 µm quartile, and 76% (49/64) in the 650-1416 µm quartile. Using receiver operating characteristic and area under the curve analysis, the maximum sensitivity and specificity was obtained with a cutoff ≤ 630 µm (sensitivity 76.7%, specificity 69.2%) giving a Youden index (J) of 0.46. One hundred and forty-six eyes (56.6%) improved by 0.3 logMAR units from their preoperative best-corrected visual acuity at 3 months following surgery.CONCLUSION:
This study shows that standard FTMH surgical repair has very high success rate up to 650 µm. It may suggest that there is a need for a reclassification of large FTMH, and new surgical techniques such as internal limiting membrane flaps should be reserved for macular holes larger than 650 µm.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Perfurações Retinianas
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Vitrectomia
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Tamponamento Interno
Tipo de estudo:
Observational_studies
/
Prognostic_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Am J Ophthalmol
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Reino Unido