Poor preoperative visual acuity, perioperative complications, age-related macular degeneration and delay to surgery are significant predictors of final visual acuity outcomes in patients who underwent small-gauge vitrectomy for full-thickness macular hole, according to a study.
Data from 132 eyes of 122 patients were collected after a mean of 22.2 months’ follow-up and analyzed in a retrospective noncomparative, nonrandomized study. All patients underwent pars plana vitrectomy (PPV) with or without internal limiting membrane peeling at Retina Consultants of Houston and were reviewed after at least 1 year of follow-up. Patients with combined retinal detachment and full-thickness macular hole and patients who had a prior PPV operation were excluded from the study.
PPV was primarily small gauge, as 130 patients were operated using 23- or 25-gauge systems.
Main outcome measures were logMAR visual acuity at 1 year and at the final follow-up visit.
On average, patients experienced an improvement in visual acuity at 1 year postoperatively from logMAR 0.94 to logMAR 0.47, with logMAR 0.43 at the final visit.
Patients with pseudophakic eyes showed an improvement from preoperative logMAR 0.94 to logMAR 0.47 at 1 year and logMAR 0.46 at the final follow-up.
Of the 132 eyes examined, 114 (86.3%) showed improvement in visual acuity at the final follow-up.
The macular hole closure rate was 97.7% (129 eyes) after 1 year. Two eyes showed no improvement after PPV as the hole remained open, and one patient developed an eccentric hole in the superior macula after vitrectomy. At the final follow-up, 128 of the holes remained closed, with one hole reopening and no repeat PPV performed because the patient was lost to follow-up.
As expected, poor preoperative visual acuity and perioperative complications significantly affected the visual acuity outcome at the final follow-up visit. The presence of AMD was also “a comparable and significant predictor of poor visual outcome.” Another significant predictor was identified by this study as the length of delay to surgery.
“Given that the effect of this factor manifested only with longer-term follow-up, previous investigations may not have discovered this result due to earlier termination of data collection,” the authors said.
Reasons for delay to surgery from preoperative appointment included “patient or staff scheduling difficulties, insurance coverage delays, lack of patient-perceived urgency and other social factors,” they wrote. – by Michela Cimberle
Disclosures: Amram reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.