Results of surgical treatment of recent-onset full-thickness idiopathic macular holes

E. H. Ryan Jr and H. D. Gilbert
Phillips Eye Institute, Minneapolis, Minn.

OBJECTIVE: To investigate whether the visual prognosis after macular hole surgery was different between recent and older holes and to evaluate preoperative characteristics and variations in surgical technique that may influence outcome. DESIGN: The medical charts of all our patients who underwent surgery for a full-thickness macular hole were retrospectively reviewed. PATIENTS: Forty-eight eyes of 48 patients in the "early" group (symptoms < or = 6 months), and 20 eyes of 19 patients in the "late" group (symptoms > 6 months). INTERVENTION: Vitrectomy, separation of the posterior hyaloid, gas tamponade, and instructions to be face down for 1 week. Most patients had epiretinal membrane dissection. MAIN OUTCOME MEASURES: The early and late groups were compared regarding anatomic and visual outcomes. In the early group we evaluated the effect on outcome of the stage of the hole, intraocular tamponade, membrane dissection, and travel distance. RESULTS: Median postoperative visual acuity in the early group was 20/40 at 3, 6, and 12 months. Fifteen (56%) of 27 patients gained at least three lines of vision at 12 months. Anatomic success was seen with one operation in 75% (36/48), and with two operations in 87.5% (42/48). Stage 2 holes had a final anatomic success rate of 94.4%. Of respondents to an informal survey, 63.4% (26/41) believed that vision was greatly improved, and 70.3% (26/37) said that they would definitely choose surgery again. In the late group, median postoperative visual acuity was 20/100 at 6 months, compared with 20/142 preoperatively. Closure of the hole with one operation was seen in 60% (12/20) of the patients in the late group. CONCLUSIONS: Surgery in patients with recent macular holes has a better prognosis for visual rehabilitation than with older holes and appears to be considered beneficial by most patients.

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