Aim: To determine whether the efficacy of re-operation for idiopathic full-thickness macular hole (FTMH) remaining open after initial surgery with ILM peeling is correlated with macular hole configuration as determined by optical coherence tomography (OCT), macular hole size, macular hole duration before the first operation, or type of tamponade (gas or silicone oil).
Methods: A retrospective consecutive interventional case series of 28 patients (28 eyes) with a persisting macular hole after vitrectomy, internal limiting membrane peel, and gas tamponade. 28 patients underwent repeat surgery involving vitrectomy and gas (n=15) or silicone oil tamponade (n=12) or no tamponade (n=1). Autologous platelet concentrate (n=22), autologous whole blood (n=1), or no adjuvant (n=5) was used. Pre-operative OCT was undertaken in all eyes. The main outcome measures were anatomic closure and improvement of best-corrected visual acuity (BCVA).
Results: Anatomic closure was achieved in 19 of 28 eyes (68%). BCVA improved in 12 eyes, remained unchanged in 9, and worsened in 7. BCVA improved in 11 of 19 eyes with anatomic closure, and in 1 of 8 eyes without closure. Anatomic closure and improvement of BCVA correlated with pre-operative macular hole configuration on OCT, with higher rates of closure (18 of 20 eyes versus 1 of 8 eyes, p=0.001) and greater improvement of BCVA (p=0.048) in eyes with a cuff of subretinal fluid at the break margin. Macular hole size, type of tamponade, macular hole duration before the first operation, or pre-operative BCVA did not significantly correlate with visual or anatomic outcome. Conclusions: Macular hole configuration seems to be a strong prognostic indicator of anatomic closure and may help identify those patients most likely to benefit from re-operation.
- Macular hole