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

Idiopathic full-thickness macular holes result from changes at the vitreomacular interface, which, in turn, lead to perifoveal cortical vitreous traction. If untreated, most iFTMHs will progress in size and grade with increasing central visual loss.

A Systematic review and meta-analysis Pubmed.gov and Cochrane Library were searched by Gerard et al for studies in presenting outcomes of idiopathic full-thickness macular hole that FTC or RO to evaluate repeated surgery for idiopathic full-thickness macular hole that failed to close (FTC) after first surgery or reopened (RO) once originally closed.

Anatomical closure, postoperative best-corrected visual acuity, intraoperative/postoperative complications, and patient-reported outcomes were noted. Meta-analysis was performed on aggregate and available individual participant data sets.

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