Macular Hole Surgery as a Historical Perspective.

Area of Science:

• Ophthalmology
• Retinal Surgery
• Surgical Outcomes

Background:

• Macular hole (MH) surgery has evolved since its inception in 1991.
• Understanding the historical progression of surgical outcomes is vital for current practice.

Purpose of the Study:

• To historically evaluate the outcomes of macular hole (MH) surgery.
• To identify factors influencing surgical success over time.

Main Methods:

• Retrospective review of 1032 eyes (949 patients) undergoing MH surgery from 1990-2016.
• Phacovitrectomy with posterior hyaloid and epiretinal membrane removal, SF6 gas tamponade, and 1-week face-down positioning.
• Internal limiting membrane (ILM) peeling adopted as standard after 1998; surgeries divided into four periods.

Main Results:

• Initial closure rates improved from 61.3% to 96.4% across periods.
• Final visual acuity (VA) improved, with rates of 0.5 or better increasing from 48.2% to 88.8%.
• Hole duration and ILM peeling were significant predictors of anatomic and functional outcomes.

Conclusions:

• Favorable outcomes in MH surgery are primarily linked to earlier surgical intervention and conventional ILM peeling.
• Conventional ILM peeling alone may be sufficient to achieve favorable results.