Advances and Outcomes for Macular Hole Surgery

1. Advances and Outcomes for Macular Hole Surgery The outcome of macular hole surgery has improved exponentially over the past few years with a closure rate of between ninety and one hundred percent. At the same time, some macular hole types have not enjoyed the same success. The internal limiting membrane peeling improves the success rate, though research has shown it could also result in mechanical and subclinical traumatic changes in the retina. Macular holes can be full thickness or partial thickness with their pathogenesis being idiopathic or myopia, trauma, or another cause. Before vitreoretinal surgery, there was no treatment for macular holes. Some do close spontaneously. Macular hole surgery has undergone advancements with an improved closure rate and visual recovery, with internal limiting membranes significantly improving the closure rate. Seventy-three percent of patients who have macular hole surgery have a successful outcome with an improvement in vision. With improvements in surgical techniques, the closure rate is improving and the visual acuity recovery has also improved. Visual acuity outcomes differ based on the type of macular hole the surgeon is dealing with. When you compare idiopathic macular holes to high myopic macular holes the visual outcomes for myopic macular holes are limited. In idiopathic macular holes, the final visual acuity is approximately 20/50 following internal limiting membrane peeling. Those with high myopia saw an improvement of 0.63 and those without high myopia showed an improvement of 0.48. The visual outcome is less successful in those with high myopic eyes. The visual acuity improvements differ based on the stage of the macular hole and the type of stain used in the internal limiting membrane. Some macular holes can close spontaneously, but this is only four percent in those with stage three and four macular holes and eleven percent in those with stage two macular holes. Since the introduction of vitreoretinal surgery, the closure rate has improved increasing to fifty-eight percent. With advancements in technology and medicine, the new surgical techniques and instrument improvements have helped increase the closure rate to ninety percent. In addition to this, the diameter of the macular hole is an important consideration when it comes to the closure rate. Those with a diameter of less than 400um sees a very high closure rate of up to ninety-seven percent, while those with a diameter of more than 500um have a fifty percent closure rate. The closure rate differences are caused by the hole diameter and the associated Gass stage. Postoperative macular holes are divided into four groups; U-shaped closures, irregular closures, open or flat closures, and V-shaped closures. U-shaped closures are normal contours that offer the best visual outcomes and occur in approximately forty-five percent of patients. The V-shaped closure is a steep contour and is present in around twenty-six percent of patients with a less favorable visual outcome. Irregular closures are irregular and occur in just shy of nine percent of cases. Open or flat closures have defects on the retina with flattened fluid around the hole, occurring in around nineteen percent of patients. The recovery for these closures is very limited. Vitreoretinal surgery or vitrectomy is the surgical method used to repair macular holes and has a

2. success rate of around ninety percent. This surgical technique is a day-case surgery carried out by a retinal specialist. They make a minute cut in the eye and remove the vitreous gel, repair the hole, and then fill the hole with gas or air. How the patient follows post-operative instructions will determine the overall success rate of the surgery. About Us: Mahi Muqit is a leading consultant ophthalmologist, cataract, and vitreoretinal surgeon at two private clinics in London, United Kingdom. He provides patients with superior service and support with a range of surgical procedures to meet their eyesight requirements. He has built up a solid reputation for his eye services in the London area as an expert eye doctor and surgeon offering surgical retina, medical retina, and complex cataract surgery. He also offers surgery to patients suffering from diabetic retinopathy. Mahi Muqit is a member of the Royal College of Ophthalmologists, a member of the British and Eire Association of Vitreoretinal Surgeons, and the UK and Ireland Society of Cataract and Refractive Surgeons. To find out more, visit http://www.retinasurgeon.uk.