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Ophthalmology. 2013 Mar;120(3):629-634. doi: 10.1016/j.ophtha.2012.09.003. Epub 2012 Dec 1.

United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 2, macular hole.

Author information

1
King's College London, London, United Kingdom. Electronic address: t.jackson1@nhs.net.
2
The Royal College of Ophthalmologists' National Ophthalmology Database, London, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom.
3
The Royal College of Ophthalmologists' National Ophthalmology Database, London, United Kingdom; Bristol Eye Hospital, and Bristol University, Bristol, United Kingdom.

Abstract

PURPOSE:

To study macular hole (MH) surgery in terms of baseline demographics, intraoperative complications, post-vitrectomy cataract, reoperation, and visual outcome.

DESIGN:

National Ophthalmology Database study.

PARTICIPANTS:

A total of 1078 eyes from 1045 patients undergoing primary MH surgery.

METHODS:

Participating centers prospectively collected clinical data using a single electronic medical record (EMR) system, with automatic extraction of anonymized data to a national database, over 8 years. The following data were extracted for eyes undergoing MH surgery: demographics, procedure elements, intraoperative complications, visual acuity (VA), and further surgery.

MAIN OUTCOME MEASURES:

Description of the primary procedures performed, intraoperative complication rate, change in VA, proportion of eyes undergoing subsequent surgery for persisting MH, cataract, or retinal detachment.

RESULTS:

The median age was 70.3 years, with a 2.2:1 female preponderance. All operations included a pars plana vitrectomy (PPV)-41.1% with hexafluoroethane (C2F6), 25.6% with perfluoropropane (C3F8), 24.5% with sulfahexafluoride (SF6), 2.2% with air, and 0.4% with silicone oil. A PPV was combined with internal limiting membrane (ILM) peel in 94.1% and cataract surgery in 40.5%. One or more intraoperative complications occurred in 12.4%. The median presenting logarithm of the minimum angle of resolution (logMAR) VA improved from 0.80 to 0.50 after a median follow-up of 0.6 years; 57.8% of eyes improved ≥0.30 logMAR units (∼2 Snellen lines). The choice of gas tamponade did not significantly influence the visual outcome, but eyes undergoing ILM peel were significantly more likely to gain ≥0.30 logMAR units, as were eyes with poor presenting VA. Subsequently, 4.2% of eyes underwent repeat surgery for MH and 2.4% for retinal detachment, and, excluding pseudophakic eyes, 64.6% underwent cataract surgery within 1 year.

CONCLUSIONS:

This study provides pooled, anonymized data on the demographics, complications, and visual outcome of MH surgery. This may enable vitreoretinal surgeons to benchmark their case-mix and outcomes, and facilitate risk-benefit and cost-benefit analyses.

PMID:
23211634
DOI:
10.1016/j.ophtha.2012.09.003
[Indexed for MEDLINE]

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