Evaluation of predictors for anatomical success in macular hole surgery in Indian population

The aim was to evaluate outcomes and predictors for anatomical success in macular hole (MH) surgery.

This was a prospective cohort study of patients operated for idiopathic MH with stages II, III or IV. Patients underwent pars plana vitrectomy with internal limiting membrane (ILM) peeling, internal gas tamponade, and postoperative face down positioning. The primary outcome measure was anatomical closure of MH, while secondary outcome measure was postoperative external limiting membrane (ELM) continuity. Effect of MH size, duration of MH, size of ILM peel, type of gas tamponade (SF6 vs. C3F8) and macular hole index (MHI) on anatomical MH closure was also evaluated.

Of the 62 eyes operated, anatomical closure of MH was achieved in 55 eyes (88.7%). The median duration of follow-up was 8 months (range: 6-15 months). Mean BVCA improved from 0.94 ± 0.26 at baseline to 0.40 ± 0.23 logMAR at last follow-up (P = 0.01). There was a statistically significant association between size of ILM peel and anatomical closure of MH (P = 0.04). Duration of symptoms, size of MH, type of gas tamponade, MHI had no effect on anatomical closure (P = 0.22, 0.28, 0.40 respectively, Chi-square test). Postoperative continuity of the ELM was significantly associated with a shorter symptom duration (<6 months) before surgery.

Acceptable anatomical closure could be attained with the defined technique. Size of ILM peel is a new predictor of anatomical success while symptom duration affects postoperative ELM continuity.