Resurgery or Reopening of first failed macular hole: Which is better?

Twenty-eight eligible studies were identified. After reoperation, pooled estimates for anatomical closure were 78% (95% confidence interval 71–84%) and 80% (95% confidence interval 66–89%) for FTC and RO groups, respectively. On average, best-corrected visual acuity improved in both groups. However, only 15% (28 of 189 eyes) of FTC eyes achieved best-corrected visual acuity of ≥6/12. The pooled estimated probability of ≥2-line best-corrected visual acuity improvement was 58% in the FTC group (95% confidence interval 45–71%); meta-analysis was not possible in the RO group. The most common complication was cataract.

The study concluded "Reoperation for FTC or RO idiopathic full-thickness macular hole achieved a clinically meaningful visual acuity improvement in more than half of patients; high levels of vision (≥6/12), however, were uncommon."

This review and meta-analysis indicated , "Just more than half of the patients undergoing a second surgery for FTC iFTMH are likely to experience visual acuity improvement of ≥2 Snellen lines after a second surgery, with a small risk of complications. Only a small proportion of these (15%), however, may achieve very good vision (≥6/12). There was weak evidence that visual success may be higher in the RO group. Repeated surgery is likely to lead to anatomical closure of the iFTMH in a high proportion of patients with FTC and RO iFTMHs (estimated at 78 and 80%, respectively). This information is useful for the counseling of patients before surgery."

doi: 10.1097/IAE.0000000000002564