Einfluss der Lochbreite auf Visus, Endotamponade und Verschlussrate beim Makulaforamen

Abstract

The influence of the width of a full-thickness macular hole on preoperative visual acuity and its role for the intraoperative approach and closure rate were analysed in a prospective study. For 47 patients with a full thickness macular hole, a precise analysis of the central retina was performed with SD-OCT. An SF-gas-air mixture was used, with a lower concentration (15 %) for smaller holes ≤ 400 µm (group 1, n = 17) and a higher concentration (30 %) for larger holes > 400 µm (group 2, n = 30). Besides preoperative visual acuity, postoperative IOP fluctuations and closure rate were reviewed. The mean hole width with SD-OCT was 419 ± 155 µm, with a significant negative correlation with preoperative visual acuity (r = - 0.56, p = 0.002). In the first group, mean early postoperative IOP was 23 mmHg and in the second group 33 mmHg (p< 0.001). Thus, for small macular holes, early postoperative IOP decompensation from gas expansion in the eye could be minimised. The closure rate was 90 %, with no significant difference between the two groups (p > 0.05). Determining the width of a macular hole with SD-OCT is an important indicator for the necessary endotamponade. Using a lower gas concentration (15 %) for smaller holes (≤ 400 µm) to prevent postoperative IOP fluctuations does not negatively influence closure rates.

Frequently assessed and used prognostic factors for outcome after macular hole surgery: which is better?

“…Although several of the evaluated parameters were correlated with the surgical and visual outcomes in our study, the minimum linear diameter (MLD) was the only parameter showing predictive properties in both the linear and logistic regression analyses. Although the significance of the MLD might be somewhat limited due to poor intra-and interindividual repeatability in manual OCT diameter measurements, as recently shown by Antonopoulou, the correlation of preoperative macular hole diameter and outcome was documented in several earlier studies [2,3,9,16,22,[25][26][27]. In our study, the MLD was a stronger predicator for postoperative VA than the basal diameter or the manually marked MH area (Fig.…”