Ethnic variation in primary idiopathic macular hole surgery

Abstract

PurposeThe purpose of the study was to investigate the role of ethnicity on idiopathic macular holes (IMH) structure and surgical outcome. This was a retrospective review.Patients and methodsConsecutive patients undergoing primary IMH surgery at two surgical sites of Moorfields Eye Hospital (London, UK) between April 2012 and June 2013. The main outcome measure was post surgical anatomical closure of IMH.ResultsTwo hundred and twenty two primary IMH surgeries were undertaken. A standard procedure including pars plana vitrectomy, internal limiting membrane peeling, and gas tamponade was undertaken for all cases. 61.3% of patients were Caucasian, 21.2% were South Asian, and 16% were Afro-Caribbean. The mean minimum linear diameter (MLD) for our cohort was 434.6 mcm. Mean MLD was 395.3 mcm in Caucasian patients, 490.0 mcm in South Asians (P=0.006), and 491.4 mcm in Afro-Caribbeans (P=0.007). Regression analysis demonstrated that MLD and Afro-Caribbean ethnicity were independent significant risk factors for surgical failure (OR: 1.01, P<0.001 and OR: 5.73, P=0.008, respectively).ConclusionSouth Asian and Afro-Caribbean patients present with larger IMH than Caucasians. In addition to IMH diameter, Afro-Caribbean ethnicity is an independent risk factor for surgical failure.

Outcome of Revision Procedures for Failed Primary Macular Hole Surgery

“…Furthermore, a variety of different adjunctive procedures are often used to augment full-thickness macular hole (FTMH) closure; examples include repeat fluid-gas exchange with or without extending the extent of the ILM peel, radial nerve fibre layer (NFL) incisions, ILM flaps, retinal massage, autologous platelets, and microdrain procedures. 5,6 The relative effects of these adjunctive techniques are disputed with some concerns that successful closure is not always accompanied by improvement in vision.…”

“…Risk factors affecting primary closure, such as age, hole size, hole duration, myopia, internal limiting membrane (ILM) peeling, and preoperative visual acuity [1][2][3][4] are established, and outcomes are frequently positive with reported closure rates of 85% to 96%. 2,5,6 However, despite the high success rate of primary surgery, nonclosure does occur and factors affecting the outcome of revision surgery are less established. Previous articles, including a recent meta-analysis, 7 have investigated success rates in revision surgery, yet the visual benefits are unclear, with patients grouped categorically into gains of greater or less than 10 letters.…”

The Evolution and Visual Prognosis of Glial Proliferation with Different Grades after Macular Hole Surgery: An Optical Coherence Tomography-Based Study

“…In addition, the follow-up duration of 10 months may not be sufficient to fully observe the evolution of glial proliferation because in this study the significant resolution of the glial proliferation was identified in only one-half of the eyes. Moreover, the ethnic variation is an independent factor associated with the surgical prognosis [22, 23]. As a result, the findings of this study might not be reproducible with other ethnicities.…”

Idiopathic Macular Hole: Algorithm for Nonsurgical Closure Based on Literature Review

“…According to two US research and two UK studies, people of African descent tend to have bigger IFTMH sizes than people of Caucasian ancestry, which may be related in part to their delayed presentation, and longer wait times for surgery. [ 13 , 14 , 15 , 16 ]…”