Analysis of factors associated with vision and hole closure for idiopathic macular hole after vitrectomy surgery_Chinese Journal of Ocular Fundus Diseases

Authors：

Song Shuang , Gu Xiaoya , Lu Yingyi ,  Yu Xiaobing , Dai Hong

Department of Ophthalmology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China;

Corresponding author：

Yu Xiaobing, Email: yuxiaobing@sina.com

Keywords：

Retinal perforations/surgery; Vitrectomy; Root cause analysis

DOI：

10.3760/cma.j.issn.1005-1015.2017.04.005

Video：

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Objective To investigate the factors associated with vision and hole closure for idiopathic macular hole (IMH) after vitrectomy surgery. Methods Eighty-nine eyes of 89 patients with IMH were enrolled in this retrospective study. There were 15 males and 74 females. The patients aged from 42 to 82 years, with the mean age of (64.13±7.20) years. All subjects underwent best corrected visual acuity (BCVA) and optical coherence tomography (OCT) examinations. The BCVA ranged from 0.01 to 0.4, with the mean BCVA of 0.12±0.09. The MH stages was ranged from 2 to 4, with the mean stages of 3.56±0.77. The basal diameter ranged from 182 μm to 1569 μm, with the mean basal diameter of (782.52±339.17) μm. The treatment was conventional 25G pars plana vitrectomy combined with phacoemulsification and intraocular implantation. Forty-one eyes received internal limiting membrane peeling and 48 eyes received internal limiting membrane grafting. The follow-up ranged from 28 to 720 days, with the mean follow-up of (153.73±160.95) days. The visual acuity and hole closure were evaluated on the last visit and the possible related factors were analyzed. Results On the last visit, the BCVA ranged from 0.02 to 0.8, with the mean BCVA of 0.26±0.18. Among 89 eyes, vision improved in 45 eyes (50.56%) and stabled in 44 eyes (49.44%). Eighty-six eyes (96.63%) gained MH closure but 3 eyes (3.37%) failed. By analysis, patients of early stages of MH and smaller basal diameter of MH will gain better vision outcome (t=2.092, 2.569; P＜0.05) and patients of early stage MH will gain high hole closure rate after surgery for IMH (t=−5.413, P＜0.05). However, gender, age, duration, preoperative BCVA, surgery technique, gas types and follow-up time had no relationship with the effect after surgery for IMH (P＞0.05). Conclusions Stages of MH and basal diameter of MH may be the factors associated with the visual outcome for idiopathic macular hole after surgery. However, age, gender, duration, surgery patterns, gas types and follow-up time showed no effects on operational outcomes.

Citation： Song Shuang, Gu Xiaoya, Lu Yingyi, Yu Xiaobing, Dai Hong. Analysis of factors associated with vision and hole closure for idiopathic macular hole after vitrectomy surgery. Chinese Journal of Ocular Fundus Diseases, 2017, 33(4): 346-349. doi: 10.3760/cma.j.issn.1005-1015.2017.04.005 Copy

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2.	Roth DB, Smiddy WE, Feuer W. Vitreous surgery for chronic macular holes [J]. Ophthalmology, 1997, 104(12): 2047-2052.
3.	Tirelli F, Sasso P, Scupola A. Idiopathic macular hole: post-operative morpho-functional assessment and prognostic factors for recovery of visual acuity [J]. Ann Ist Super Sanita, 2013, 49(3): 313-316. DOI: 10.4415/ANN_13_03_14.
4.	Salter AB, Folgar FA, Weissbrot J, et al. Macular hole surgery prognostic success rates based on macular hole size [J]. Ophthalmic Surg Lasers Imaging, 2012, 43(3): 184-189. DOI: 10.3928/15428877-20120102-05.
5.	夏红和, 陈伟奇, 陈浩宇. 特发性黄斑裂孔患眼玻璃体切割手术视力预后影响因素分析[J]. 中华眼底病杂志, 2016, 32(5): 478-480. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.005.Xia HH, Chen WQ, Chen HY. Analysis of factors affecting the visual outcome after vitrectomy for idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 478-480. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.005.
6.	Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(6): 629-639.
7.	Leonard RE 2nd, Smiddy WE, Flynn HW Jr, et al. Long-term visual outcomes in patients with successful macular hole surgery[J]. Ophthalmology, 1997, 104(10): 1648-1652.
8.	Takamura Y, Tomomatsu T, Matsumura T, et al. Correlation between central retinal thickness after successful macular hole surgery and visual outcome[J]. Jpn J Ophthalmol, 2015, 59(6): 394-400. DOI: 10.1007/s10384-015-0406-0.
9.	吴鹏, 黄旭东, 孙先勇, 等. 内界膜撕除及其联合内界膜移植治疗特发性黄斑裂孔的疗效对比观察[J]. 中华眼底病杂志, 2014, 30 (3): 253-256. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.007.Wu P, Huang XD, Sun XY, et al. Efficacy of internal limiting membrane peeling and transplantation for the treatment of idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2014, 30 (3): 253-256. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.007.
10.	Miehalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes [J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/j.ophtha.2010.02.011.
11.	Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia[J]. Am J Ophthalmol, 2013, 156(1): 125-131. DOI: 10.1016/j.ajo.2013.02.014.
12.	Kase S, Saito W, Mori S, et al. Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique[J]. Clin Ophthalmol, 2016, 11: 9-14. DOI: 10.2147/OPTH.S119762.
13.	鲁静, 马志中. 玻璃体切割手术联合空气或C₃F₈填充治疗特发性黄斑裂孔的疗效对比观察[J]. 中华眼底病杂志, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.Lu J, Ma ZZ. Clinical outcomes of C₃F₈ and air tamponade after vitrectomy for the treatment of idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.

1. Shah SP, Manjunath V, Rogers AH, et al. Optical coherence tomography guided facedown positioning for macular hole surgery [J]. Retina, 2013, 33(2): 356-362. DOI: 10.1097/IAE.0b013e318263d0e8.
2. Roth DB, Smiddy WE, Feuer W. Vitreous surgery for chronic macular holes [J]. Ophthalmology, 1997, 104(12): 2047-2052.
3. Tirelli F, Sasso P, Scupola A. Idiopathic macular hole: post-operative morpho-functional assessment and prognostic factors for recovery of visual acuity [J]. Ann Ist Super Sanita, 2013, 49(3): 313-316. DOI: 10.4415/ANN_13_03_14.
4. Salter AB, Folgar FA, Weissbrot J, et al. Macular hole surgery prognostic success rates based on macular hole size [J]. Ophthalmic Surg Lasers Imaging, 2012, 43(3): 184-189. DOI: 10.3928/15428877-20120102-05.
5. 夏红和, 陈伟奇, 陈浩宇. 特发性黄斑裂孔患眼玻璃体切割手术视力预后影响因素分析[J]. 中华眼底病杂志, 2016, 32(5): 478-480. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.005.Xia HH, Chen WQ, Chen HY. Analysis of factors affecting the visual outcome after vitrectomy for idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 478-480. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.005.
6. Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(6): 629-639.
7. Leonard RE 2nd, Smiddy WE, Flynn HW Jr, et al. Long-term visual outcomes in patients with successful macular hole surgery[J]. Ophthalmology, 1997, 104(10): 1648-1652.
8. Takamura Y, Tomomatsu T, Matsumura T, et al. Correlation between central retinal thickness after successful macular hole surgery and visual outcome[J]. Jpn J Ophthalmol, 2015, 59(6): 394-400. DOI: 10.1007/s10384-015-0406-0.
9. 吴鹏, 黄旭东, 孙先勇, 等. 内界膜撕除及其联合内界膜移植治疗特发性黄斑裂孔的疗效对比观察[J]. 中华眼底病杂志, 2014, 30 (3): 253-256. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.007.Wu P, Huang XD, Sun XY, et al. Efficacy of internal limiting membrane peeling and transplantation for the treatment of idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2014, 30 (3): 253-256. DOI: 10.3760/cma.j.issn.1005-1015.2014.03.007.
10. Miehalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes [J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/j.ophtha.2010.02.011.
11. Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia[J]. Am J Ophthalmol, 2013, 156(1): 125-131. DOI: 10.1016/j.ajo.2013.02.014.
12. Kase S, Saito W, Mori S, et al. Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique[J]. Clin Ophthalmol, 2016, 11: 9-14. DOI: 10.2147/OPTH.S119762.
13. 鲁静, 马志中. 玻璃体切割手术联合空气或C₃F₈填充治疗特发性黄斑裂孔的疗效对比观察[J]. 中华眼底病杂志, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.Lu J, Ma ZZ. Clinical outcomes of C₃F₈ and air tamponade after vitrectomy for the treatment of idiopathic macular hole[J]. Chin J Ocul Fundus Dis, 2016, 32(5): 473-477. DOI: 10.3760/cma.j.issn.1005-1015.2016.05.004.

Chinese Journal of Ocular Fundus Diseases

Analysis of factors associated with vision and hole closure for idiopathic macular hole after vitrectomy surgery

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