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Am J Ophthalmol. 2018 Nov;195:36-42. doi: 10.1016/j.ajo.2018.07.027. Epub 2018 Jul 30.

The Manchester Large Macular Hole Study: Is it Time to Reclassify Large Macular Holes?

Author information

1
Manchester Royal Eye Hospital, Manchester, United Kingdom.
2
Manchester Royal Eye Hospital, Manchester, United Kingdom. Electronic address: assad.jalil@mft.nhs.uk.

Abstract

PURPOSE:

To evaluate anatomic and functional outcomes of full-thickness macular holes (FTMH) larger than 400 μm following vitrectomy, internal limiting membrane peel, gas tamponade, and face-down posturing.

DESIGN:

A retrospective interventional case series.

METHODS:

A total of 258 consecutive eyes with FTMH larger than 400 μm were enrolled at the Manchester Royal Eye Hospital study over a 5-year period from 2012 to 2017. All eyes underwent pars plana vitrectomy, ILM peel, and gas tamponade. Anatomic success rates were measured. A correlation between macular hole size and closure was evaluated.

RESULTS:

A total of 258 eyes were analyzed. The anatomic closure rate was 89.92%. When divided into quartiles, the closure rate of FTMH was 98% (64/65) in the 400-477 μm quartile, 91% (59/65) in the 478-558 μm quartile, 94% (60/64) in the 559-649 μm quartile, and 76% (49/64) in the 650-1416 μm quartile. Using receiver operating characteristic and area under the curve analysis, the maximum sensitivity and specificity was obtained with a cutoff ≤ 630 μm (sensitivity 76.7%, specificity 69.2%) giving a Youden index (J) of 0.46. One hundred and forty-six eyes (56.6%) improved by 0.3 logMAR units from their preoperative best-corrected visual acuity at 3 months following surgery.

CONCLUSION:

This study shows that standard FTMH surgical repair has very high success rate up to 650 μm. It may suggest that there is a need for a reclassification of large FTMH, and new surgical techniques such as internal limiting membrane flaps should be reserved for macular holes larger than 650 μm.

PMID:
30071212
DOI:
10.1016/j.ajo.2018.07.027

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