DIRECT MACULAR HOLE MANIPULATION RESULTS IN HIGH SUCCESS RATE IN SECONDARY MACULAR HOLE REPAIR. Issue 4 (April 2023)

• Record Type: Journal Article
• Authors: Schönbach, Etienne M.; Knight, Darren K.; Wu, Chris Y.; Arevalo, J. Fernando; Bittencourt de Souza, Luiza; Cheng, Lingyun; Chhablani, Jay; Delalibera Pacheco, Kátia; Feucht, Nikolaus; Kozak, Igor; Maia, André; Maier, Mathias; Roizenblatt, Marina; Smiddy, William E.; Sobol, Warren M.; Freeman, William R.
• Is Part Of: Retina. Volume 43:Issue 4(2023)
• Page Start: 555
• Page End: 559
• Publication Date: 2023-04
• Subjects: macular hole -- internal limiting membrane -- autologous retinal transplant -- amniotic membrane -- repeat -- failed macular hole surgery -- vitrectomy; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000003712
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : The authors review cases of macular holes that failed primary closure. Repeat surgery was performed using tissue transplantation, flaps of internal limiting membrane, macular hole manipulation, and repeat internal limiting membrane peeling. Closure rates were lowest for repeat internal limiting membrane peeling but overall acceptable anatomical closure rates were achieved in all groups. Abstract : Purpose: To investigate closure rates and functional outcomes of surgery for refractory and recurrent macular holes (MHs) in a real-world setting. Methods: Retrospective review of secondary MH surgeries. Results: A total of 72 eyes from 72 patients were included. Eyes had a mean of 1.51 surgeries before inclusion into this study with a mean MH size of 762 µ m and a mean baseline logarithm of the minimum angle of resolution best-corrected visual acuity of 1.11 (∼20/260 Snellen). Closure rates were 89.3% for tissue transplantation, 77.3% for internal limiting membrane (ILM) flaps, 92.9% for MH manipulation, and 12.5% for repeat ILM peeling ( P < 0.05). Best-corrected visual acuity changes in logarithm of the minimum angle of resolution from baseline to postoperative month six were +0.29 for ILM peeling alone (15 Early Treatment Diabetic Retinopathy Study letters worse), −0.39 for MH manipulation (20 Early Treatment Diabetic Retinopathy Study letters improved), −0.23 for tissue transplantation (13 Early Treatment Diabetic Retinopathy Study letters improved), and −0.2 for ILM flaps (10 Early Treatment Diabetic Retinopathy Study letters improved; P < 0.05). Conclusion: Secondary MH closure is possible using various surgical techniques with acceptable anatomical closure rates. Repeat ILM peeling is associated with the lowest closure rates and poorest functional results. To distinguish between techniques would require a large sample size of approximately 750 eyes.