Long-term anatomic and visual outcomes of initially closed macular holes

Abstract

Purpose: To evaluate the anatomic and visual outcomes in patients with initially closed macular holes after vitreoretinal surgery and with 1 to 7 years of follow-up.

Design: Retrospective, noncomparative, consecutive case series.

Methods: Eighty-seven consecutive eyes of 79 patients with previous closure of the macular holes and with at least 1 year of follow-up were reviewed in this retrospective clinical study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes.

Results: The mean age of enrolled patients was 63.1 ± 6.2 years (range, 49 to 74 years); the mean duration of macular hole was 5.6 ± 9.7 months (range, 0.25 to 60 months); and the mean follow-up interval was 38.4 ± 19.7 months (range, 12 to 86 months). All eyes underwent internal limiting membrane peeling during the vitrectomy, and 64 (73.6%) of 87 eyes underwent cataract extraction. No reopening of initially closed macular holes was observed in any eyes. Slight perifoveal epiretinal membranes were observed by optical coherence tomography in 32.2% of cases (28/87). The final best-corrected visual acuity improved to 0.47 ± 0.39 logarithm of the minimal angle of resolution units, which was significantly higher than preoperative visual acuity of 1.01 ± 0.36 logarithm of the minimal angle of resolution units (t = -12.532; P = .000). Multiple linear regression analysis demonstrated that the final best-corrected visual acuity was affected by the macular hole stage, preoperative best-corrected visual acuity, and cataract exaction (F = 19.858; P = .000).

Conclusions: The stable closure of macular holes is achieved after vitrectomy with internal limiting membrane peeling. Phacoemulsification cataract surgery with intraocular lens implantation for improvement of visual function is not responsible for the reopening of previously closed macular holes.