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Anatomical Results

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Let’s start with the anatomical results. The success rate is  85.7%. You may comment that it looks disappointing and slightly below the average you find in the papers, however

Let’s start with the anatomical results. The success rate is 85.7%. You may comment that it looks disappointing and slightly below the average you find in the papers, however

We have to go through the statistical analysis to really say something valuable and these are the statistical studies that have been performed for the anatomical results in order to find the best predictors for anatomical success. You see all the variables that were considered and among them only some resulted significant predictors.

We have to go through the statistical analysis to really say something valuable and these are the statistical studies that have been performed for the anatomical results in order to find the best predictors for anatomical success. You see all the variables that were considered and among them only some resulted significant predictors.

So what is crucial to close a hole? This is a list in decreasing order of significance of the best predictors for hole closure. Let’s comment on some of them.

So what is crucial to close a hole? This is a list in decreasing order of significance of the best predictors for hole closure. Let’s comment on some of them.

The frequency of hole closure is higher if we operate early stages. Please notice the failure rate which is 4 times higher in stage 4 when compared to stage 1-2.

The frequency of hole closure is higher if we operate early stages. Please notice the failure rate which is 4 times higher in stage 4 when compared to stage 1-2.

When do surgeons operate the holes? From the table you observe that 54.5% of cases were operated within 4 months. Which is good but NOT GOOD ENOUGH because

When do surgeons operate the holes? From the table you observe that 54.5% of cases were operated within 4 months. Which is good but NOT GOOD ENOUGH because

As you see in the graph, the probability to close the hole is higher when we operate early after diagnosis. The data is highly significant. If we operate within one month the success rate goes up to 92% so you see, this is much closer or even higher than many published papers.

As you see in the graph, the probability to close the hole is higher when we operate early after diagnosis. The data is highly significant. If we operate within one month the success rate goes up to 92% so you see, this is much closer or even higher than many published papers.

So the first take home message is DON’T WAIT.

So the first take home message is DON’T WAIT.

What about dyes: well, it is certainly better to use a dye.

What about dyes: well, it is certainly better to use a dye.

Even in stage 4, where the closure rate is 78.2%, running a multivariate analysis to study which are the best predictors to close chronic holes is THE USE OF A DYE.

Even in stage 4, where the closure rate is 78.2%, running a multivariate analysis to study which are the best predictors to close chronic holes is THE USE OF A DYE.

You are now wondering which is the winning dye, which is the best. Here is the graph NO, NO PLEASE WAIT AND DON’T WITHDRAW ANY WRONG CONCLUSION !  I know you already making classifications. You should not look at the black line but at the red bars. If we draw this green line you notice that the red bar intersect. Do you know what does this mean in statistical language?

You are now wondering which is the winning dye, which is the best. Here is the graph NO, NO PLEASE WAIT AND DON’T WITHDRAW ANY WRONG CONCLUSION ! I know you already making classifications. You should not look at the black line but at the red bars. If we draw this green line you notice that the red bar intersect. Do you know what does this mean in statistical language?

It means that there is no statistically significant difference among dyes.

It means that there is no statistically significant difference among dyes.

So I am giving you a very threatening take home message : TO CLOSE YOU DYE.

So I am giving you a very threatening take home message : TO CLOSE YOU DYE.

To close you dye sounds threatening for a reason: the use of dye does not improve nor limit visual outcome.

To close you dye sounds threatening for a reason: the use of dye does not improve nor limit visual outcome.

Macular-Hole-Study-19

Well every dye was used in every stage, although there was a slight tendency to use trypan blu mainly in later stages. At this point there could be also differences among countries and doctors that I will not go into now.

Well every dye was used in every stage, although there was a slight tendency to use trypan blu mainly in later stages. At this point there could be also differences among countries and doctors that I will not go into now.

Macular-Hole-Study-21

Everybody peeled. In fact 95.7% of you were 100% sure to have peeled the ilm. If we add to these sure people 3.3% who are only probably sure to have peeled, we are left with only 1% of surgeons who did not peel, but this is not enough to make statistical comments.

Everybody peeled. In fact 95.7% of you were 100% sure to have peeled the ilm. If we add to these sure people 3.3% who are only probably sure to have peeled, we are left with only 1% of surgeons who did not peel, but this is not enough to make statistical comments.

Let’s move to type of tamponade by looking at the graph. What does this mean? It means that there is not statistically significant difference among tamponades.

Let’s move to type of tamponade by looking at the graph. What does this mean? It means that there is not statistically significant difference among tamponades.

So, you may wonder whether it is important to tamponade anyway, and the answer is yes it is. And we see that from the significance of postoperative positioning that has a p value lower than 0,001.

So, you may wonder whether it is important to tamponade anyway, and the answer is yes it is. And we see that from the significance of postoperative positioning that has a p value lower than 0,001.

If we run a bivariate analysis on the influence of postoperative positioning, as you see the difference is not significant. However bi-variate have limited value.

If we run a bivariate analysis on the influence of postoperative positioning, as you see the difference is not significant. However bi-variate have limited value.

From these graphs you notice that there is a tendency to counsel a longer duration of positioning for later stages. BUT: Is it really necessary?

From these graphs you notice that there is a tendency to counsel a longer duration of positioning for later stages. BUT: Is it really necessary?

If you look at the graph you see that when the tamponade is complete, if you don’t look up, the probability of closure is almost 85%. It is higher if the position is strict. Less understandable is the high success rate with don't look up with respect to strict in case of incomplete tamponade.

If you look at the graph you see that when the tamponade is complete, if you don’t look up, the probability of closure is almost 85%. It is higher if the position is strict. Less understandable is the high success rate with don’t look up with respect to strict in case of incomplete tamponade.

The following graph is telling us the same information, which is that the position strict is correlated to high success rate and it gives an additional information about DURATION: a. The position strict  associated to a complete tamponade is successful at any duration of positioning, at one day and at 14 days. this is interesting because it is telling us that is it not necessary to position for long time.  b. Top right you see that the position strict is also efficient with incomplete tamponade at any duration. However look at the red bars: they tell you that this data is less reliable. c. On bottom left you see that if you keep the position DON’T LOOK UP with a complete tamponade, the success is very high, but only with a DURATION of 4-5 days. d. Same concept if you tell the patient DON’T LOOK UP with an incomplete tamponade.

The following graph is telling us the same information, which is that the position strict is correlated to high success rate and it gives an additional information about DURATION:a. The position strict associated to a complete tamponade is successful at any duration of positioning, at one day and at 14 days. this is interesting because it is telling us that is it not necessary to position for long time.b. Top right you see that the position strict is also efficient with incomplete tamponade at any duration. However look at the red bars: they tell you that this data is less reliable.c. On bottom left you see that if you keep the position DON’T LOOK UP with a complete tamponade, the success is very high, but only with a DURATION of 4-5 days.d. Same concept if you tell the patient DON’T LOOK UP with an incomplete tamponade.

The final warning is that it is not possible to give conclusive counseling on positioning with the data collected so far.

The final warning is that it is not possible to give conclusive counseling on positioning with the data collected so far.

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