98th Annual Meeting DOG 2000

P 759

Predictive factors in macular hole surgery

C. A. Gass, S. Ullrich, C. Haritoglou, M. Schaumberger, M. Thiel, A. Kampik

Purpose: To evaluate predictive factors for postoperative anatomical and functional outcome in macular hole surgery.

Method: In a prospective study 98 of 105 patients were examined with Optical Coherence Tomography (OCT) before pars plana vitrectomy. Measured diameters and calculated Hole Form Factor (HFF) according to Puliafito were correlated with the postoperative anatomic success and best visual acuity. Duration of symptoms was correlated with postoperative visual acuity, base and minimum diameter of the macular hole.

Results: In eyes with persisting macular hole after one surgical approach (13/98) the base diameter as well as the minimum diameter of the holes were significantly larger (p=0.003; p=0.028) than in cases with immediate anatomic hole closure. Significant negative correlation between both the base and the minimum diameter of the hole and postoperative visual function was found (p=0.016; p=0.002). In all patients with HFF>0.9 the macular hole was closed with one approach while in eyes with HFF<0.5 anatomic success rate was 67 %. Better postoperative visual outcome correlated with higher HFF (p=0.050). There was no significant correlation between duration of symptoms (2-24 months) and postoperative visual acuity (p>0.4) or the measured diameters (p=0.053; p=0.164).

Discussion: Preoperative measurement of macular hole size with OCT is prognostic for postoperative visual outcome and anatomical result. In our series duration of symptoms correlated neither with the postoperative visual outcome nor the measured diameters of the macular hole.

Department of Ophthalmology, Ludwig-Maximilians-Universit├Ąt, D-80336 Munich, Germany