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Visual consequence of delayed macular hole surgery

Session Details

Session Title: Miscellaneous

Session Date/Time: Thursday 17/09/2015 | 11:00-12:30

Paper Time: 11:08

Venue: Athena.

First Author: : J.Phillips UNITED KINGDOM

Co Author(s): :    F. DhawahirScala   J. Phillips   N. Patton        

Abstract Details

PURPOSE:To determine the relationship between the time from diagnosis to surgical treatment of macular hole and its effect on macular hole size, closure success and visual outcome.

Setting:

Large tertiary referral teaching hospital

Methods:

We undertook a retrospective audit on 18 cases who had been diagnosed and treated as having macular hole surgery between the dates of 01 March 2013 and 01 March 2014, under the direct care of two vitreoretinal consultants (NP and FDS). Patients required a minimum follow-up of 6 months. The size of the macular hole (maximal diameter) was determined using spectral domain OCT at the time of the patient being diagnosed with a macular hole, and also on the day of their macular hole surgery. The relationship between the change in size of the macular hole (in microns) and the duration (in days from diagnosis to surgery) was determined. In addition, any relationship between delay of macular hole treatment, and final visual outcome, as well as success of macular hole closure was determined.

Results:

In total, 18 cases were analysed with full data. Of the 18 patients, mean (+/- SD) macular hole size at first diagnosis was 427 (+/- 165) microns. Mean (+/- SD) macular hole size at day of surgery was 560 (+/- 119) microns (mean increase in size 133 microns, range 9-469 microns). Mean time (days) between diagnosis and surgery was 150 (+/- 105). The mean time delay was not correlated with change in macular hole size (R = 0.1, p>0.05). 18/18 cases had anatomical hole closure. Median visual change (from first diagnosis to final follow-up) was 0.1 (IQ range 0.0 -- 0.2) LogMAR. There was no correlation between delay in surgery and visual improvement (R=0.05, p>0.05). There was no correlation between change in macular hole size and visual improvement (R=-0.3, p>0.05).

Conclusions:

Our study demonstrated only a small increase in size of macular hole over the time frame of this study which because of its magnitude did not correspond to an adverse visual outcome. Previous studies have demonstrated long delays in surgery from diagnosis result in significantly less likelihood of macular hole closure, which would correspondingly result in poor visual outcomes. Our study suggests that if delays for surgery are modest, this does not adversely affect anatomical closure or visual outcome.

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