Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan;35(1):316-325.
doi: 10.1038/s41433-020-0844-x. Epub 2020 Mar 30.

Factors affecting anatomical and visual outcome after macular hole surgery: findings from a large prospective UK cohort

D H Steel  1   2 , P H J Donachie  3 , G W Aylward  4 , D A Laidlaw  5 , T H Williamson  5 , D Yorston  6 ; BEAVRS Macular hole outcome group
Collaborators, Affiliations

Factors affecting anatomical and visual outcome after macular hole surgery: findings from a large prospective UK cohort

D H Steel et al. Eye (Lond). 2021 Jan.

Abstract

Objectives: To reassess the definition of a large macular hole, factors predicting hole closure and post-surgery visual recovery.

Design: Database study of 1483 primary macular hole operations. Eligible operations were primary MH operations treated with a vitrectomy and a gas or air tamponade. Excluded were eyes with a history of retinal detachment, high myopia, previous vitrectomy or trauma.

Results: A higher proportion of operations were performed in eyes from females (71.1%) who were 'on average' younger (p < 0.001), with slightly larger holes (p < 0.001) than male patients. Sulfur hexafluoride gas was generally used for smaller holes (p < 0.001). From 1253 operations with a known surgical outcome, successful hole closure was achieved in 1199 (96%) and influenced by smaller holes and complete ILM peeling (p < 0.001), but not post-surgery positioning (p = 0.072). A minimum linear diameter of ~500 μm marked the threshold where the success rate started to decline. From the 1056 successfully closed operations eligible for visual outcome analysis, visual success (defined as visual acuity of 0.30 or better logMAR) was achieved in 488 (46.2%) eyes. At the multivariate level, the factors predicting visual success were better pre-operative VA, smaller hole size, shorter duration of symptoms and the absence of AMD.

Conclusions: Females undergoing primary macular hole surgery tend to be younger and have larger holes than male patients. The definition of a large hole should be changed to around 500 μm, and patients should be operated on early to help achieve a good post-operative VA.

PubMed Disclaimer

Conflict of interest statement

DS has received fees as a consultant for Alcon, Orbit Biomedical and Novartis, and research funding from Alcon and Bayer. TW has received consultancy, author or lecturing fees from or has a financial relationship with Valeant Bausch and Lomb, Kingston upon Thames, UK, Alcon Laboratories, Camberley, UK, Oxular Biotech, Oxford, UK, Galecto Biotech, Copenhagen, Denmark, Axsys Technologies, Glasgow, UK, Springer Publishers, Berlin, Germany, CRC Press, Boca Raton, Florida, USA and Daybreak Medical, London, UK. AL, DY, PD and GA declare no conflicts of interest

Figures

Fig. 1
Fig. 1. Cumulative frequency of macular hole diameter.
a Macular hole diameter and patients’ gender, N = 1,483 primary macular hole operations. b Macular hole diameter and ocular tamponade, N = 1,479 primary macular hole operations. Four operations that used air tamponade not included.
Fig. 2
Fig. 2. Macular hole surgery failed closure rates.
95% confidence intervals shown for 50 micron increments of the hole diameter in microns, N = 1,253 primary macular hole operations with a known surgical outcome.
See this image and copyright information in PMC

Comment in

References

    1. Meuer SM, Myers CE, Klein BE, Swift MK, Huang Y, Gangaputra S, et al. The epidemiology of vitreoretinal interface abnormalities as detected by spectral-domain optical coherence tomography: the beaver dam eye study. Ophthalmology. 2015;122:787–95. doi: 10.1016/j.ophtha.2014.10.014. - DOI - PMC - PubMed
    1. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991;109:654–9. doi: 10.1001/archopht.1991.01080050068031. - DOI - PubMed
    1. Madi HA, Masri I, Steel DH. Optimal management of idiopathic macular holes. Clin Ophthalmol. 2016;10:97–116. - PMC - PubMed
    1. Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 2010;117:2018–25. doi: 10.1016/j.ophtha.2010.02.011. - DOI - PubMed
    1. Jackson TL, Donachie PHJ, Sparrow JM, Johnston RL. United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 2, macular hole. Ophthalmology. 2013;120:629–34. doi: 10.1016/j.ophtha.2012.09.003. - DOI - PubMed

Publication types