Predicting Visual Recovery in Long-Standing Macular Holes: Surgical Strategies and Role of Optical Coherence Tomography Biomarkers.

Abstract

BACKGROUND Macular hole (MH) duration is a prognostic indicator of posttreatment visual outcomes. The aim was to evaluate chronic (≥12 months) MH treatment using extended internal limiting membrane (ILM) peeling. MATERIAL AND METHODS Medical records of patients with chronic MH treated with pars plana vitrectomy, ILM peeling (up to vascular arcades), and 20% SF6 tamponade were reviewed. Spearman correlation coefficient (r) examined relationships between MH duration and best-corrected visual acuity (BCVA). RESULTS Fifty patients were included (72.0% women; mean age, 73 years); mean (SD) MH duration was 19.1 (8.8) months. Most (76.0%) patients had a preoperative MH diameter >400 µm (mean [SD], 569.2 [164.6] µm). The MH was closed within 1 week in 46 (92.0%) patients. A significant improvement from baseline in BCVA was observed by month 1 after treatment (mean [SD] logMAR, 0.96 [0.38] vs 0.66 [0.25]; P<0.001). A moderate positive correlation was observed between MH duration and posttreatment BCVA (logMAR; r=0.40; P<0.01). Improvements in mean logMAR values through month 24 were similar when patients were stratified by MH diameter (≤400 vs >400 µm; P>0.05; all time points). Significant differences between patients with baseline MH diameter of ≤650 µm vs >650 µm were observed for BCVA (logMAR; P≤0.03; all time points). CONCLUSIONS Twenty-four month follow-up revealed a steady increase in visual acuity, with no symptom worsening. Vitrectomy, extended ILM peeling, and gas tamponade is effective for chronic MH closure, including for holes of up to 650 µm in diameter. A MH diameter >650 µm was associated with poorer BCVA results after treatment.