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Persistent macular holes — what is the best strategy for revision?

  • Retinal Disorders
  • Published:
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Abstract

Purpose

This study aims to analyze the success rate and functional outcome after revision surgery of persistent idiopathic full-thickness macular holes in a large patient cohort and to identify the optimal tamponade strategy and the value of new adjunctive manipulation techniques for persistent macular hole (pMH) closure.

Methods

Retrospective, comparative, non-consecutive case series of all revisional surgeries for idiopathic pMH between 2011 and 2019 at the Eye Clinic Sulzbach were identified. Of 1163 idiopathic MH surgeries, 74 eyes of 74 patients had pMH. Of those, group 1 (n = 38) had vitrectomy with tamponade alone (20% sulfur hexafluoride gas, 15% hexafluoroethane gas, silicone oil 5000, Densiron®), while group 2 (n = 36) included tamponade with adjuvant manipulation (internal limiting membrane (ILM) translocation, subretinal fluid injection, epiretinal amniotic membrane, free retina graft, or autologous blood). Main statistical outcomes were anatomic closure rate, visual acuity (VA), minimum linear diameter (MLD), and base diameter (BD).

Results

Overall total anatomical success rate was 81.1% and mean VA improved 3.5 lines from LogMAR 1.03 ± 0.30 to 0.68 ± 0.38 (p < .001). Preoperative MLD or BD had no effect on total anatomic success (p = 0.074, p = 0.134, respectively). When comparing the two groups, slightly better anatomic success rates were achieved in group 1 (84.2%) compared to that in group 2 (77.8%) (p = 0.68). Final VA in group 1 (LogMAR 0.67 ± 0.39) outperformed group 2 (LogMAR 0.86 ± 0.38) (p = 0.03).

Conclusions

Revisional surgery for persistent idiopathic MH with tamponade alone had comparable anatomical closure but better VA outcomes, compared to tamponade with adjuvant manipulation.

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Data availability

All data are within the manuscript.

Code availability

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Author information

Authors and Affiliations

  1. Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10 66280, Sulzbach, Germany

    Peter Szurman, Philip Wakili, Boris V. Stanzel, Karl T. Boden & Annekatrin Rickmann

  2. Klaus Heimann Eye Research Institute, Sulzbach, Germany

    Peter Szurman & Boris V. Stanzel

  3. Work and Organizational Psychology, Saarland University, Saarbrücken, Germany

    Rudolf Siegel

Authors
  1. Peter Szurman
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  2. Philip Wakili
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  3. Boris V. Stanzel
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  4. Rudolf Siegel
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  5. Karl T. Boden
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  6. Annekatrin Rickmann
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Contributions

Conceptualization: Peter Szurman; methodology: Peter Szurman; formal analysis and investigation: Philip Wakili, Peter Szurman, Rudolf Siegel, Annekatrin Rickmann, and Boris Stanzel; writing—original draft preparation: Peter Szurman and Annekatrin Rickmann; writing—review and editing: Boris Stanzel, Rudolf Siegel, Annekatrin Rickmann, and Karl Boden.

Rudolf Siegel conducted the statistical analysis.

All authors have approved the submitted version.

Corresponding author

Correspondence to Peter Szurman.

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The study was approved by the Ethics Committee of the Medical Association of Saarland (Nr. 243/14) and adheres to the tenets of the Declaration of Helsinki.

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Szurman, P., Wakili, P., Stanzel, B.V. et al. Persistent macular holes — what is the best strategy for revision? . Graefes Arch Clin Exp Ophthalmol 259, 1781–1790 (2021). https://doi.org/10.1007/s00417-021-05252-7

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  • DOI: https://doi.org/10.1007/s00417-021-05252-7

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