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Persistent subretinal fluid after successful full thickness macular hole surgery- prognostic factors, morphological features and implications on functional recovery

Session Details

Session Title: Vitreoretinal Surgery III

Session Date/Time: Friday 12/09/2014 | 08:00-10:00

Paper Time: 08:00

Venue: Boulevard E

First Author: : P.Stavrakas GREECE

Co Author(s): :    A. Vakalis   S. Asteriadis   E. Lokovitis   P. Tranos     

Abstract Details

Purpose:

The purpose of the this study was to investigate on the pre-operative factors that are significantly associated with the presence of persistent subretinal fluid (SRF) after successful macular hole (MH) surgery, and to determine whether this postoperative retinal defect is correlated with the final anatomic and functional outcomes.

Setting:

“Ophthalmica” Vitreoretinal Unit, Thessaloniki and 2nd Department of Ophthalmology, University of Athens, Greece

Methods:

Thirty-five eyes of 34 patients with idiopathic full thickness macular hole (FTMH) scheduled for surgery between March 2011 and March 1012 were retrospectively enrolled in this study. Exclusion criteria were any ocular co-morbidities affecting visual acuity such as corneal opacities, glaucoma, age-related macular degeneration, diabetic retinopathy and previous surgery for rhegmatogenous retinal detachment. Patients with lens opacities requiring one step cataract and macular hole surgery were also excluded for the study. Preoperatively, Spectral Domain (SD) OCT images were obtained in all patients. A standard 23 gage 3-port PPV with ILM peeling was performed in all cases. At the end of the operation, C3F8 14% or SF6 25% was used as endotamponade based on surgeon’s preference. Postoperative SD-OCT imaging evaluation included macular hole closure (which was determined as complete approximation and flattening of the hole edges), presence of SRF and measurement of base diameter of the cyst that contained SRF during the follow-up period. The mean follow-up period was 12+ 2.7 months. Numerical data were analyzed using the Wilcoxon signed rank test and Mann-Whitney U test. P<0.05 was considered statistically significant. All statistical analysis was done with SPSS software for Mac.

Results:

31 phakic and 4 pseudophakic eyes with FTMH were included in the study. There were 22 women and 12 men with a mean age of 66 years. Ten eyes (26.5%) had a stage 2 MH, 17 (50%) had a stage 3, and 8 (23.5%) had a stage 4 MH. ERM was detected in 9 eyes (25.7%), while 13 eyes (37.1%) showed a posterior vitreous attachment at one edge of the MH. Anatomical MH closure was detected in all eyes (100%). Postoperative SRF was observed in 40.0% whereas 60% showed a nearly “normal” foveal anatomy. In all cases SRF gradually decreased however only in 9 out of the 14 (64.2%) eyes had disappeared by the end of the follow up. Post-operative development of SRF was significantly associated with stage 2 FTMH (p=0.017), smaller size of the closest distance between the MH edges (p=0.046) and posterior vitreous attachment to one edge of the MH (0.048). Log MAR mean pre-operative BCVA was 0.55+0.23 and improved significantly to 0.33+0.2 (p<0.05). Post-operative BCVA at final follow-up was better in eyes that did not develop SRF compared to those with early post-op SRF (0.40+0.23 vs 0.32+ 0.20), however the difference was not statistically significant (p=0.30).

Conclusions:

The presence of postoperative SRF after successful MH closure has been reported to be a physiological finding during the healing process. Our study has comparable rates of postoperative SRF with other reports however we found a slow disappearance and persistence in a significant percentage of cases. The three prognostic factors we identified may represent an earlier stage in the natural history of macular hole, consequently holes of shorter duration may be more prone on showing SRF in the postoperative period. This may indicate that the morphological features of MH closure may not depend solely on MH stage or size but other parameters are involved. Although eyes that did not develop postoperative SRF tend to have better final visual acuity compared to eyes with resolved SRF, this difference is not statistically significant and therefore persistent SRF seem to have no effect on final visual outcome. Further studies are needed to clarify the mechanism and formation of persistent subretinal fluid especially in the era of pharmacologic vitreolysis.

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