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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.

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King's College London, London, United Kingdom. Electronic address:
The Royal College of Ophthalmologists' National Ophthalmology Database, London, United Kingdom; Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom.
The Royal College of Ophthalmologists' National Ophthalmology Database, London, United Kingdom; Bristol Eye Hospital, and Bristol University, Bristol, United Kingdom.



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


National Ophthalmology Database study.


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


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.


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.


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.


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.

[Indexed for MEDLINE]

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