OUTCOME OF REVISION PROCEDURES FOR FAILED PRIMARY MACULAR HOLE SURGERY.

PURPOSE: To analyze the outcomes of revision surgery for idiopathic full-thickness macular holes that have failed to close after primary surgery, and also to assess factors predicting success and to review the relative effect of adjunctive surgical techniques. METHODS: A multicenter retrospective study. Anatomical closure rates and visual acuity change between pre and postrevision surgery were assessed. Hole size, age, symptom duration, surgical interval, and reduced hole size were analyzed as predictive factors for success. Effectiveness of adjunctive surgical techniques was reviewed. RESULTS: Seventy-seven eyes were included in the study. Anatomical closure was achieved in 71% (55/77) cases. There was a median gain of 11 Early Treatment of Diabetic Retinopathy Score letters in all holes and 14 letters in closed holes. Full-thickness macular holes that increased in size by more than 10% following primary surgery had a closure rate of 50% compared with 80% in holes that reduced by 10% or stayed the same (P = 0.015). Increasing hole size is associated with a modest reduction in odds of closure (odds ratio = 0.99; P = 0.04). Surgical interval <2 months is not associated with better outcomes compared with >2 months (P = 0.14). CONCLUSION: Revision surgery for full-thickness macular holes that have failed to close after primary surgery is associated with high closure rates and significant visual gains.

Vision-related quality of life and visual function in patients undergoing vitrectomy, gas tamponade and cataract surgery for macular hole.

AIM: To evaluate the relationship between vision-related quality of life (VR-QOL) and visual function in patients undergoing vitrectomy, gas tamponade and cataract surgery for macular hole (MH). METHODS: The 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was self-administered by 32 patients with MH (age 66.2 (SD 5.4) years) preoperatively and at 3 months postoperatively. Clinical data were collected, including logarithm of minimum angle of resolution (logMAR) best corrected visual acuity (BCVA), severity of metamorphopsia and letter contrast sensitivity. The severity of metamorphopsia was evaluated by the M-Charts. MH index was measured using optical coherence tomography. The presence and severity of cataract were graded using the Lens Opacities Classification System III reference standards. Multiple regression analysis was performed to investigate the relationship between various explanatory variables and VFQ-25 questionnaire scores. Explanatory variables tested were the severity of metamorphopsia, visual acuity, letter contrast sensitivity, MH index and grade of cataract. RESULTS: Vitrectomy for MH significantly improved VFQ-25 composite score as well as subscale scores, including general vision, near activities, distance activities, social functioning, mental health and dependency (p<0.05, Wilcoxon signed-rank test). Multiple regression analysis revealed that, both preoperatively and postoperatively, the severity of metamorphopsia had a significant correlation with VFQ-25 composite score (p<0.05), whereas other explanatory variables did not. In addition, changes in the severity of metamorphopsia was the single variable that was significantly related to changes in VFQ-25 composite score (p<0.01). CONCLUSION: Vitrectomy for MH significantly improved VR-QOL. The severity of metamorphopsia was significantly associated with both preoperative and postoperative VR-QOL.

Visual performance 3 years after successful macular hole surgery.

BACKGROUND/AIMS: To evaluate the visual performance of patients with successful macular hole surgery with a minimum follow-up of 3 years. Results were compared with the performance of the healthy fellow eyes. METHODS: 15 patients were studied. The healthy fellow eyes of the patients (13 eyes) served as a control group. Age, gender and best-corrected logMAR visual acuity were recorded. Reading acuity (in log reading acuity determination (RAD), reading equivalent of logMAR) and speed were tested monocularly. Scotoma size was measured with SLO perimetry, and hole closure was confirmed with an OCT scan. RESULTS: The mean distance visual acuity of the operated eyes (logMAR 0.32 (SD 0.21)) was significantly lower than that of the healthy fellow eyes (logMAR 0.05 (0.17)), but significantly higher than preoperatively (logMAR 0.71 (0.32)). The mean reading acuity was logRAD 0.47 (0.25) for the operated eyes ( = 77.9% of logMAR), and statistically significantly higher (logRAD 0.16 (0.16)) for the fellow eyes ( = 89.4% of logMAR). The mean maximum reading speeds were comparable for the operated eyes (168.3 (23.1) words per minute (wpm)) and the fellow eyes (178.7 (26.1) wpm) (p = 0.3). Within logRAD 1.3 and 0.5, the mean reading speeds of the two groups were comparable, but critical print size (CPS) for the operated group (logRAD 0.7 (0.2)) was significantly worse than those for the fellow eyes (logRAD 0.4 (0.2)). The SLO analysis showed absence of absolute scotoma in 12 eyes. CONCLUSION: Distance and reading acuity showed remaining deficits compared with the healthy fellow eyes; however, mean maximum reading speeds of the operated eyes achieved results comparable with healthy eyes. The results show a long-term benefit in the visual function of eyes with closed macular holes.

Visual quality of life after macular hole surgery: outcome and predictive factors.

BACKGROUND: In the present study we evaluated the functional success after macular hole surgery in correlation to visual quality of life and looked for predictive factors determining surgical success. METHODS: Fifty-nine patients that underwent pars plana vitrectomy for idiopathic macular hole were included. Follow-up visits were performed in regular intervals after surgery and included a clinical examination, optical coherence tomography (OCT) and measurement of visual acuity. To assess the visual quality of life patients filled out the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) before and three months and one year after surgery. RESULTS: Macular hole closure was achieved in 57 of 59 patients (97%). Mean visual acuity increased from 20/100 preoperatively to 20/34 one year after surgery (p = 0.02). Despite good visual acuity (20/27) in the fellow eye, visual quality of life (VFQ composite score) rose from 75.9 +/- 14.4 (SD) to 81.5 +/- 14.2 one year after surgery (p<0.001). Although there was no correlation between the increase in visual quality of life and visual acuity, the increase in VFQ-25 could be well predicted: low visual acuity and significant impairment on VFQ-25 testing preoperatively made patients most likely to benefit from macular hole surgery. A relatively high retinal thickness measurement at the hole border measured on OCT further increases the predictive value. CONCLUSION: Macular hole surgery is associated with an increase in visual quality of life despite good visual acuity of the fellow eye. Preoperative visual acuity, VFQ-25 value and partly OCT may help to predict the increase in patients' vision related quality of life after surgery.