Outcome of macular hole surgery in a peripheral eye care facility of Nepal

Introduction: Macular hole is a full thickness defect of the retina involving anatomical fovea, which is an important cause of central visual loss. Most common cause is idiopathic. The OCT has provided information regarding pathogenesis, classification and surgical success. Purpose: The objective of this study was to find out whether two types of hole closure would show different visual prognosis and to identify the correlation between size of macular hole and the type of closure. Patients and Methods: This study consisted of a retrospective consecutive series of patients who were operated for idiopathic macular hole in R.M. Kedia Eye Hospital from January 2022 to March 2023. Among 35 eyes operated for idiopathic macular hole in the mentioned time frame, 27 eyes of 27 patients with closed macular hole after the initial operation were included in this study. All patients underwent preoperative and postoperative OCT examination of the macular lesion, including the measurement of the macular hole diameter. The successful closure of the macular hole was defined as a postoperative biomicroscopic appearance in which the rim of the macular hole disappeared or was attached to the underlying RPE with flattening of the cuff of retinal detachment around the hole. On the basis of postoperative OCT findings, the closed macular holes were classified into two groups; type 1 and type 2 closure. Results: Type 1 closure was achieved in 18 (67%) of patients and Type 2 closure in 9 (33%) of patients. Stage 2 hole patients had 100% Type 1 closure whereas Stage 3 hole patients had 50% Type 1 and 50% Type 2 closure. Significant mean difference was found in pre-operative and post-operative BCVA (P-value < 0.01). Significant mean difference in pre-operative BCVA and post-operative BCVA was also observed among patients with stage 2 (P-value < 0.01) and stage 3 (P value < 0.01). Conclusion: Smaller preoperative macular hole size will probably result in the complete sealing of the macular hole without bare RPE after operation. And the complete sealing of the macular hole without bare RPE is associated with better visual acuity, more visual improvement and less recurrence postoperatively.