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. 2024 Jun;102(4):e557-e564.
doi: 10.1111/aos.15791. Epub 2023 Oct 11.

Vitrectomy for retinal detachment associated with macular hole: Prognostic factor analysis under different axial length conditions

Zi-Qi Wang  1 , Zhao-Ze Ni  1 , Xiao-Long Zhang  1 , Xiao-Yan Lin  1 , Xu-Ting Hu  1 , Zhao-Liang Zhang  1 , Zong-Duan Zhang  1 , Qin-Tuo Pan  1
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Free article

Vitrectomy for retinal detachment associated with macular hole: Prognostic factor analysis under different axial length conditions

Zi-Qi Wang et al. Acta Ophthalmol. 2024 Jun.
Free article

Abstract

Purpose: To identify prognostic factors for complete anatomical success (CAS) under different axial length (AL) conditions after vitrectomy plus internal limiting membrane (ILM) peeling for retinal detachment associated with macular hole (MHRD).

Methods: This retrospective study included 243 patients (251 eyes) with MHRD who underwent primary vitrectomy plus ILM peeling. Multivariate logistic regression explored prognostic factors for CAS in AL <30 mm and ≥ 30 mm groups.

Results: Overall, 113 eyes (45.0% of 251) exhibited complete CAS after initial surgery. Eyes with CAS had greater best-corrected visual acuity improvement than eyes without CAS (p < 0.001). CAS was more common in eyes with AL < 30 mm (50.3% of 155) than in eyes with AL ≥ 30 mm (36.5%, 35/96; p = 0.032). In the AL < 30 mm group, CAS was associated with ILM insertion (odds ratio [OR], 2.824, 95% confidence interval [CI], 1.189-6.710; p = 0.019), silicone oil (SO)/perfluoropropane (C3F8) tamponade (SO: OR, 0.408, 95% CI, 0.191-0.873; C3F8: OR, 2.448, 95% CI, 1.145-5.234; p = 0.021) and staphyloma (OR, 0.318, 95% CI, 0.143-0.707; p = 0.005). In the AL ≥30 mm group, CAS was associated with ILM insertion (OR, 11.621, 95% CI, 2.557-52.813; p = 0.001), SO /C3F8 tamponade (SO: OR, 5.305, 95% CI, 1.206-23.334; C3F8: OR, 0.188, 95% CI, 0.043-0.829; p = 0.027) and age (OR, 0.928, 95% CI, 0.876-0.983; p = 0.011).

Conclusion: Vitrectomy plus ILM peeling can effectively treat MHRD but has limited efficacy in eyes with AL ≥ 30 mm. ILM insertion was associated with more frequent CAS at any AL. C3F8 tamponade yielded better outcomes with AL < 30 mm; SO tamponade yielded better outcomes with AL ≥ 30 mm.

Keywords: axial length; internal limiting membrane; perfluoropropane tamponade; retinal detachment associated macular hole; silicone oil tamponade; vitrectomy.

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References

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