Advantages:

To evaluate anatomical and functional results of idiopathic macular holes (IMH) surgeries.

Methods:

At the Ophthalmology department at Masaryk Hospital in Usti nad Labem we performed from January 1st 2011 until December 31st 2012 in total 36 surgeries due to IMH in 30 patients, while in 6 patients (16.7%) both eyes underwent surgery. In all patients we performed the 23G PPV with membrana limitans interna (MLI) peeling and a SF6 gas tamponade. Two surgeons were involved in all interventions. Patients were recommended to keep the pronation position of head for 1-2 weeks. We maintained an average observation period of 14.5 months (3-23 months). The period between the outset of troubles up to the surgical intervention ranged 7.1 months in average (2-16 months).

Effectiveness / Safety:

The average age of operated patients was 70.4 years (ranging from 56 to 83). IMH appeared in 19 right eyes (52.8%) and in 17 left eyes (47.2%). In 14 cases (38.9%) the IMD was classified as stage 2, in 12 cases (33.3%) as stage 3 and in 10 cases (27.8%) as stage 4. After the surgery the IMH was fully closed in 30 cases (83.3%), attached flattened edges appeared in 2 cases (5.6%) and open IMH was recorded in 4 cases (11.1%). As a successful outcome, we consider a closed IMH or IMH with clinging edges, which is 32 cases in our study (88.9%). Best-corrected visual acuity (BCVA) was evaluated according to ETDRS charts. The input BCVA ranged from 0.05-0.32, in average 0.14. The outcome BCVA ranged between 0.05-0.8, in average 0.29. Improvement in BCVA was achieved in 27 eyes (75%), equal BCVA in 4 eyes (11.1%) and deteriorated BCVA was reported in 5 cases (13.9%).

Take home message:

The excellent anatomical outcome (closing the IMH in 88.9%) was followed by an improvement in BCVA in 75% of eyes. Despite achieving a closure of the macular hole, in long-term IMH the BCVA remained equal. The best improvement of BCVA was achieved through a timely performed surgery after discovering the IMH. In majority of patients we observed disappearing of metamorphopsies and a decrease or disappearing of central scotoma. Even in patients whose BCVA did not improve the metamorphopsies were reduced.