Prognostic Factors for Visual Outcomes in Closed Idiopathic Macular Holes after Vitrectomy: Outcomes at 4 Years in a Monocentric Study

Abstract

Purpose: To identify predictive factors of visual outcomes in the eyes after successful macular hole (MH) surgery.

Methods: It is a retrospective monocentric study of the eyes that underwent successful vitrectomy for full-thickness MH in an academic, tertiary care center (CHU de Québec-Université Laval, Québec, Canada) between 2014 and 2018. We included a single eye per patient and excluded the eyes with ocular comorbidities. Clinical and anatomical features of patients were collected, including demographics, MH duration, baseline MH size, baseline visual acuity (VA), and final VA. Multiple logistic regressions were performed to determine predictive factors of VA ≥70 ETDRS letters (Snellen equivalent: 20/40) and VA gain ≥15 ETDRS letters at final follow-up. Areas under the receiver operating characteristic curve (AUC) were used to determine the performance of each model and identify the Youden index maximizing performance at a given threshold.

Results: A total of 460 eyes were included in this study; 274/460 eyes (60%) achieved final VA ≥70 ETDRS letters and 304/460 eyes (66%) had a VA gain ≥15 ETDRS letters at 24 months follow-up. Multiple logistic regression analyses showed that the main predictive factors for final VA ≥70 ETDRS letters (model AUC = 0.716) were baseline VA (OR = 1.064; p < 0.001), MH duration (OR = 0.950; p=0.005), and age (OR = 0.954; p=0.004). Predictors of VA gain ≥15 ETDRS letters at final follow-up (model AUC = 0.615) were baseline VA (OR = 0.878; p < 0.001), MH duration (OR = 0.940; p < 0.001), and MH size (OR = 0.998; p=0.036). Thresholds for the final VA ≥70 ETDRS letters model and the VA gain ≥15 ETDRS letters model were VA ≥55.5 ETDRS letters (Snellen equivalent: 6/30) and MH size of 237 μm, respectively.

Conclusion: The eyes with shorter MH duration, smaller MH size, and higher preoperative VA achieved better visual outcomes after successful MH surgery.

Figure 1

Long-term visual results after MH surgery for final VA ≥70 ETDRS letters and VA gain ≥15 ETDRS letters. BCVA ≥70 ETDRS letters (whole cohort). BCVA ≥70 ETDRS letters (baseline pseudophakic eyes). ≥15 ETDRS letters increase in acuity (whole cohort). ≥15 ETDRS letters increase in acuity (baseline pseudophakic eyes).

Figure 2

ROC curves for visual outcomes. (a) Baseline BCVA for ≥70 ETDRS letters at last follow-up. (b) MH size for VA gain ≥15 ETDRS letters between baseline and final follow-up.