Early intervention for idiopathic full thickness macular holes provide better visual outcomes: Study

In a new study conducted by Declan C. Murphy and team, it was shown that in patients undergoing surgery for idiopathic full thickness macular holes (iFTMH), symptom duration was independently correlated with both structural and visual results. The findings of this study were published in Ophthalmology Journal.

IFTMH has an incidence of up to 0.5% and are visually incapacitating. Best corrected visual acuity (BCVA) drops to 20/200 when left untreated. Surgery can restore eyesight and repair holes. Although the impact of symptom duration on surgical results is unknown. Therefore, using individual participant data (IPD) research of randomized controlled trials, this study sought to establish the impact of symptom duration on outcomes in patients having surgery for iFTMH. Primary iFTMH completion and post-operative best corrected visual acuity were the outcomes evaluated.

For this study, in people with iFTMH who had vitrectomy with gas tamponade, a systematic review found eligible RCTs in which symptom duration, primary iFTMH closure, and post-operative BCVA were noted. The search for publications published between 2000 and 2020 was conducted using bibliographic databases. 

The key findings of this review were:

1. There were 20 qualifying RCTs found. Data from all research was sought, and 12 studies, totaling 940 eyes, provided the data.

2. The median number of months with symptoms was 6.

3. In 81.5% of eyes, primary closure was accomplished.

4. Predicted likelihood of closure and symptom duration had a linear relationship.

5. According to multilevel logistic modeling, the probabilities of closure were 0.965 times lower for every extra month of duration.

6. Primary closure was more likely in patients who had internal limiting membrane (ILM) peeling, intra-operative ILM flap usage, improved pre-operative BCVA, face-down orientation, and lower iFTMH sizes.

7. In eyes that experienced primary closure, the average post-operative BCVA was 0.52 logMAR (20/66).

8. For eyes that had already experienced primary iFTMH closure, multilevel logistic regression revealed that each extra month of symptom persistence was linked to a 0.008 logMAR unit deterioration in BCVA.

9. Improved post-operative BCVA was also linked to ILM flaps, intra-ocular tamponade with long-acting gas, better pre-operative BCVA, lower iFTMH size, and phakic status.

In conclusion, the authors recommend that patients with primary macular holes, especially those with smaller macular holes, be sent for surgery at the earliest to preserve eyesight.

Reference: 

Murphy, D. C., Al-Zubaidy, M., Lois, N., Scott, N., & Steel, D. H. (2022). The effect of macular hole duration on surgical outcomes: An individual participant data study of randomised controlled trials. In Ophthalmology. Elsevier BV. https://doi.org/10.1016/j.ophtha.2022.08.028