Anatomical and Functional Outcome Following Surgery of Idiopathic Macular Hole.

Abstract

Macular hole is a full thickness defect at the centre of macula. Pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade helps to close the hole and improves visual function. Aim of this study was to assess the anatomical and functional outcome following surgery of idiopathic macular hole. This interventional study was conducted in the Department of Vitreo retina, National institute of ophthalmology and hospital, Dhaka from December 2020 to August 2022. A total, 50 patients having idiopathic macular hole were included during the study period according to selection criteria. Preoperative logarithm of minimal angle of resolution (logMAR) visual acuity was measured and Optical Coherence Tomography (OCT) was done for further staging of hole. Pars plana vitrectomy, ILM peeling assisted with Brilliant blue G dye and perfluoropropane gas tamponade was done under local anesthesia. Patients were instructed to maintain a facedown position for two weeks. Postoperatively, patients were examined on day one, day seven, after one and three months. At each follow up visual acuity, ocular examination and measurement of intraocular pressure was done. OCT was done to assess anatomical closure of hole and final visual outcome was measured as best corrected visual acuity (BCVA) at three months after surgery. After data collection data were coded, entered and analyzed in a computer. Statistical test was done by windows software using statistical package for social science (SPSS) statistics for Windows, Version 26.0. Male female ratio was 1:2.3. Among 50 patients, majority (29; 58.0%) were in stage II macular hole. Duration of symptoms was more than five months before surgery in 35(70.0%) patients. Majority of study patients (82.0%) were phakic. Preoperative BCVA was found as 1.48-1.00 logMAR in 33(66.0%) patients. BCVA (0.94±0.13 vs. 0.62±0.26 in logMAR) was significantly (p<0.001) improved after macular hole surgery. Macular hole was closed in majority (45; 90%) of the study patients. Preoperative BCVA and stage of macular hole were significant factors for visual improvement. This study revealed that the overall closure rate of macular hole was satisfactory and BCVA was significantly improved during the last follow up.