Predicting visual outcome after macular hole surgery using fundus ‐ controlled microperimetry

Abstract

Purpose to explore the value of fundus‐controlled (micro)perimetry in determining the functional state of macular retina in order to predict the functional results of vitrectomy surgery in patients with idiopathic macular hole (MH). Methods Design: prospective study of 16 eyes with idiopathic MH (recruited regardless of the size of the holes and visual acuity). Pre‐ and postoperative examination additionally included microperimetry and fixation assessment performed with Maia microperimeter (CenterVue). Average retinal sensitivity was measured in the area of 1 (foveal) and 3 (parafoveal) degrees from the foveal center. Results Before surgery foveal retinal sensitivity fluctuated overall on group from 7.6 to 26.76dB (average 19.04 dB), a parafoveal sensitivity – from 16.33 dB to 29.79dB (average 24.83dB). After surgery average foveal sensitivity imroved by 4dB (up to 23.09dB), while parafoveal remained nearly unchanged (average ‐ 25.43dB). Based on microperimetric results patients were divided into two groups: patient with rather high initial foveal sensitivity (more than 21dB, Group A ‐ 9 eyes) and patient with reduced sensitivity (up to 21dB, Group B ‐ 7 eyes). Although both groups were comparable by initial VA (0,18 and 0,11), BCVA in the group A improved after surgery in average up to 0.61 (0,4‐1,0), whereas in the group B improvement of BCVA was less significant ‐ in average up to 0.31 (0,2‐0,5). Preoperative fixation stability was significantly higher in the first group (78% compared to 55%, P<0,05). Baseline MH size was slightly larger in group B (min 416mu vs 342mu; max 984vu vs 650mu in Group A). Conclusion Preoperative foveal sensitivity correlates with visual outcome in MH surgery and could be used as a predictive factor.