MACULAR HOLE REPAIR

ars plana vitrectomy (PPV) for macular hole repair is a highly effective procedure with optimal results occurring in patients with smaller holes and good preoperative visual acuity, a study presented at the 2015 Irish College of Ophthalmologists annual conference in Westport concluded.

Hadia Paryani MB.BCh.BAO.BA, a basic specialist trainee at the Royal Victoria Eye and Ear Hospital (RVEEH), Dublin, Ireland, presented the results of a study that evaluated the functional and anatomical outcomes of 25-gauge PPV for macular hole repair over a two-year period (2012-2014) in a single Irish centre under a single surgeon, Mr Dara Kilmartin, Consultant Ophthalmic Surgeon at RVEEH.

All procedures included internal limiting membrane peeling with the vital retinal membrane stain, Brilliant Blue G and postoperative posturing as standard protocol. The average follow-up was 12 months. Forty-seven patients underwent 25-gauge PPV for the treatment of macular hole repair over the two-year study period. The average age of diagnosis was 71.8 years.

Preoperatively, the majority of these eyes had a significant cataract, and about 30 per cent were pseudophakic.

The majority of patients presented with a stage 2 macular hole. There were three cases of bilateral macular holes, while 22 cases underwent simultaneous cataract extraction and intraocular lens (IOL) implantation, Dr Paryani reported.

CLOSURE RATE

The macular hole closure rate at the postoperative visit was, in line with similar international studies, 78 per cent, with two further cases demonstrating hole closure at the three- and six-month follow-up visits, bringing the total hole closure rate to 80 per cent. Hole closure was maintained at 12 months of follow-up in all cases. Dr Paryani noted the macular hole closure rate was inversely proportional to hole size at presentation. “Most of the stage 2 and stage 3 holes closed, however only three out of the eight stage 4 holes closed postoperatively,†she said.

Overall, there was a clinically significant 0.25 improvement in visual acuity according to the LogMAR scale over three months, which increased to 0.35 at one year. This was as a result of subsequent phacoemulsification and IOL implantation surgery as well as YAG capsulotomy in a number of cases. Some 19 per cent of patients had increased intraocular pressure postoperatively, while eight per cent developed significant cataracts at three to six months. Retinal detachments occurred in four per cent of cases, which were subsequently repaired.

Summarising the study findings, Dr Paryani said shorter duration of symptoms, hole stage and better preoperative visual acuity were associated with both anatomical success and regaining visual acuity of LogMAR 0.38 (6/15 postoperatively).

Hadia Paryani: paryanih@tcd.ie