Name

Facteurs pronostiques pour la chirurgie des trous maculaires idiopathiques : large étude rétrospective de 462 yeux

Few studies have evaluated factors associated with visual acuity improvement in cases of successfully operated idiopathic macular hole. The aim of this study is to determine factors associated with final visual acuity of 70 letters or more (Snellen equivalent: 20/40) after a successful primary surgery for idiopathic macular hole.

Closed full-thickness macular holes after primary surgery were identified from a cohort of consecutive patients operated for idiopathic macular hole between 2014 and 2018 at Centre Hospitalier Universitaire de Québec – Université Laval (Canada). We included a single eye per patient and excluded eyes with ocular comorbidities with a potentially detrimental effect on VA. Clinical and anatomical features of patients were collected, including demographic characteristics, macular hole duration, baseline macular hole size, baseline visual acuity, and visual acuity after surgery (Snellen visual acuity converted to ETDRS scale for analysis). Patients were divided into two groups based on final visual acuity: <70 letters and ≥70 letters. A multivariable logistic regression analysis was performed to determine predictive factors of visual acuity ≥70 letters at final follow-up.

In our cohort of 462 eyes, 60% (275/462) of eyes had visual acuity of 70 letters or more. The mean postoperative follow-up was 18 months. Macular hole duration before surgery was similar between both groups (<70 letters: 19 ± 20 weeks vs. ≥70 letters: 15 ± 11 weeks; p=0.06), while baseline macular hole size was greater in patients with worse final visual acuity (<70 letters: 411 ± 180 (97-1001) μm vs. ≥70 letters: 318 ± 148 (50-808) μm; p<0.001). Baseline visual acuity was also worse in patients with worse final visual acuity (<70 letters: 44 ± 16 letters vs. ≥70 letters: 56 ± 12 letters; p<0.001) and these patients’ visual acuity did not improve as much after the surgery (<70 letters: 14 ± 16 letters gain vs. ≥70 letters: 22 ± 12 letters gain; p<0.001). The multivariable logistic regression model (odds ratio, 95% confidence interval; p-value) showed that baseline visual acuity (1.06, 1.03-1.09; p<0.001) and postvitrectomy cataract surgery (2.51, 1.12-5.77; p=0.03) were independent predictive factors for final visual acuity ≥70 letters. Macular hole characteristics and patient age were not statistically significant: macular hole duration (0.98, 0.97-1.00; p=0.06), baseline macular hole size in µm (1.00, 1.00-1.00; p=0.26), and patient age (0.99, 0.95-1.03; p=0.69).

Independent predictive factors for better postoperative visual acuity after successful macular hole surgery included higher baseline visual acuity and postvitrectomy cataract surgery. After adjustment for these factors, the underlying macular hole size and duration, as well as patient age did not predict a final visual outcome ≥70 letters.

Our study showed that in patients with successful macular hole surgery, the subgroup of patients with higher baseline visual acuity and postvitrectomy cataract surgery had the greatest chance of achieving visual acuity of 70 letters or more, independently of the preoperative macular hole characteristics.