Retrospective study of macular holes treated with pars plana vitrectomy

Tangential vitreo-foveal traction resulting in full-thickness macular hole is an important cause of visual loss.

To determine, correlate and evaluate the factors that affect the anatomical and visual outcome of macular hole surgery.

Retrospective analysis of all cases of macular hole surgery undertaken by a single surgeon (RDB) between 1995 and 1998.

One hundred eyes were analysed with a minimum follow-up of 3 months. One operation anatomical success rate was 95%. Anatomically successful eyes had visual acuity improvement of one or more lines in 73.4% and two or more lines in 66.3%. Failure to remove diaphanous contractile 'epiretinal' membranes (presumably the internal limiting membrane) around the macular hole was significantly associated with anatomical failure (P < 0.001). Improvement of two or more lines of visual acuity was significantly associated with successful anatomical closure of the macular hole (P = 0.001). The success rate was highest in the more recent cases, suggesting a learning curve effect. Postoperatively, cataract developed or progressed in 96% of phakic eyes. Retinal detachment occurred in 6%, with all eyes having the retina reattached following subsequent surgery. Gross retinal pigment epithelial changes at the macula region developed in 3%.

Meticulous rapid dissection of adherent, diaphanous 'epiretinal' membrane around the macular hole, combined with gas tamponade and postoperative posturing, result in successful anatomical closure with improved visual acuity.