Axial Length and Outcomes of Macular Hole Surgery Assessed by Spectral-Domain Optical Coherence Tomography

• Published in: American journal of ophthalmology Vol. 151; no. 1; pp. 118 - 127.e1
• Main Authors: Suda, Kenji, Hangai, Masanori, Yoshimura, Nagahisa
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2011; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Axial Length, Eye - pathology; Basement Membrane - surgery; Biological and medical sciences; Failure; Female; Hospitals; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Myopia; Ophthalmology; Optics; Prone Position; Retinal Perforations - diagnosis; Retinal Perforations - surgery; Retinopathies; Retrospective Studies; Standard deviation; Success; Surgery; Surgical outcomes; Tomography, Optical Coherence; Tonometry, Ocular; Treatment Outcome; Veins & arteries; Visual Acuity - physiology; Vitrectomy; California; Eye disease; Macular hole; Retinopathy; Prognosis; Treatment; Optical coherence tomography; Surgery; Evolution; Maculopathy; Ophthalmology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2010.07.007

Purpose To use spectral-domain optical coherence tomography (SD OCT) to evaluate macular hole surgery outcomes and features predicting anatomic failure. Design Retrospective, interventional case series. Methods Fifty-two eyes of 50 consecutive patients with macular holes were examined. All eyes underwent 3-port pars plana vitrectomy with internal limiting membrane peeling. Eyes were examined after surgery by dense serial SD OCT scanning over the macula. Results Eyes with initial anatomic failure were significantly more likely to have greater axial length and refractive error and more posterior staphyloma compared with eyes with initial anatomic success ( P = .031 to .0060, < .0001). Overall initial and final anatomic success rates were 92.3% (48 of 52 eyes). In highly myopic eyes with axial lengths of 26.0 mm or more, initial and final success rates were 73.3% (11 of 15 eyes) compared with 100.0% (37 of 37 eyes) of eyes with axial lengths of less than 26.0 mm ( P = .0050). In highly myopic eyes, initial and final success rates were 0% (0 of 3 eyes) of eyes with axial lengths of 30.0 mm or more compared with 91.7% (11 of 12 eyes) of eyes with axial lengths of 26.0 mm or more and of less than 30.0 mm ( P < .0001). Retinoschisis-like thickening of the outer retina was seen in 3 (75.0%) of 4 eyes with initial failure compared with 3 (6.3%) of 48 eyes with initial success ( P = .0030). Conclusions Axial length of 30.0 mm or more may increase the risk of anatomic failure of macular hole surgery.