The macular microstructure repair and predictive factors of surgical outcomes after vitrectomy for idiopathic macular hole

Prognostic factors in fluid-gas exchange after primary idiopathic macular hole surgery

PURPOSE

This retrospective study aimed to evaluate the prognostic factors associated with the success of fluid-gas exchange in patients who had undergone failed primary idiopathic macular hole (IMH) surgery.

METHODS

In total, 19 eyes of 19 patients with failed IMH surgery who then underwent fluid-gas exchange were included. Of those, 18 eyes had macular hole (MH) closure (successful, 15 eyes; unsuccessful, 3 eyes). Demographics, pre-operative characteristics, and pre-procedural characteristics were assessed. The patients were divided into successful (U or V-type closure) and unsuccessful groups (W-type or unclosed), following fluid-gas exchange. One eye was unclosed after fluid-gas exchange; therefore, this patient underwent additional vitrectomy for MH closure (unsuccessful).

RESULTS

The outcomes of the fluid-gas exchange were categorized as unclosed or as U-type, V-type, or W-type closure. None of the patients experienced complications after the procedure. The successful group showed a significantly lower pre-operative and pre-procedural minimum diameter, base diameter, and macular hole volume, and higher pre-operative and pre-procedural macular hole index, hole form factor, and tractional hole index values. Moreover, a better visual prognosis was observed in the successful group.

CONCLUSION

These findings suggest that indices predicting favorable results of primary surgery for IMH are useful for predicting the success of fluid-gas exchange in patients with failed primary MH surgery.

Frequently assessed and used prognostic factors for outcome after macular hole surgery: which is better?

BACKGROUND

The aim of this retrospective study was to evaluate commonly used clinical and OCT-morphological parameters, including perifoveal pseudocysts, as prognostic factors for postoperative outcome after macular hole surgery in a retinal referral clinic in North Rhine-Westphalia, Germany.

METHODS AND MATERIAL

This was a retrospective analysis of all patients who underwent surgery because of idiopathic MH between 2011 and 2017 in Augenklinik Tausendfensterhaus, Duisburg, Germany. Statistical evaluation of clinical and OCT-based parameters, including the areas of intraretinal pseudocysts, was conducted. The main statistical outcomes were surgical success and visual acuity. Only parameters with a highly significant correlation to the outcome parameters (postoperative visual acuity (VA); surgical success) in univariate analysis were entered in linear and logistic regression analyses.

RESULTS

A total of 189 eyes of 178 patients (71.4% female; mean age 67.5 ± 8.2 a) who underwent surgery because of MH were included. The overall closure rate was 86.8%. The mean best corrected VA increased from 0.7 ± 0.3 logMAR before surgery to 0.5 ± 0.3 logMAR (p < 0.0001). While several clinical and OCT-based parameters as well as calculated indices showed a significant correlation with the outcome measures, the regression analysis showed that the minimum linear diameter was the only parameter that both predicted surgical success (p = 0.015) and was correlated with postoperative VA (p < 0.001).

CONCLUSION

The minimum linear diameter serves as an easily assessed prognostic factor with the best predictive properties. This result is of great importance for clinical practice, as it simplifies the postsurgical prognosis.

Human amniotic membrane plug to promote failed macular hole closure

The failed macular hole is a full-thickness defect involving the fovea that fails to close despite 1 or more surgeries. While many surgical options have been proposed to manage it, none of these guarantee complete anatomical success and satisfactory visual recovery. We report postoperative outcomes on 36 patients affected by failed macular hole, treated with a human amniotic membrane plug transplant. Follow-ups were performed with a standard ophthalmological examination and with advanced multimodal diagnostic imaging. Anatomical closure was achieved at 3 months in all patients. Mean best-corrected visual acuity improved statistically significantly at 6 months (p < 0.05). Through microperimetric tests, we assessed a partial recovery of the macular sensitivity on the edges of the plug. Analyzing SD-OCT images, we reported a tissutal ingrowth above the plug, and its segmentation into layers, mimicking normal retinal architecture. OCT-Angiography images non invasively analysed the retinal parafoveal capillary microvasculature; the elaboration of Adaptive Optics images showed the presence of photoreceptors at the edges of the plug. This work demonstrates not only the complete anatomical success of our technique, but also remarkable functional results, and opens the door to a greater understanding of modifications induced by the presence of a human amniotic membrane plug.