Risk Assessment of Idiopathic Macular Holes Undergoing Vitrectomy With Dye-Assisted Internal Limiting Membrane Peeling

Abstract

Simple clinical parameters such as best-corrected visual acuity, basal diameter, and perifoveal pseudocysts are efficient predictors and might be used to expand the validity of the Gass classification.

Macular Hole Surgery with Internal Limiting Membrane Peeling Facilitated by Membrane-Blue® versus Membrane-Blue-Dual®: A Retrospective Comparative Study

“…That study failed to specify just how large the holes were. Another study assessing the risk factors for nonclosure following PPV and ILM peeling reported that the closure rate for Gass stage 4 idiopathic macular holes was 78.7%, and that those with a basal hole diameter of 800  μ m or above were 4 times more likely to persist [27]. The macular holes included in the current study had a wide range of basal diameter, as illustrated in Table 1, and some had very large diameters (>1000  μ m).…”

Idiopathic Macular Hole Preferred Practice Pattern®

“…does not receive treatment. Moreover, as the macular hole enlarges, epiretinal membranes may develop and the success rate of macular hole closure with vitrectomy surgery may decrease 52. A Cochrane systematic review and meta-analysis by Parravano in 2015 has demonstrated the benefit of vitrectomy on improving visual acuity outcomes and increasing macular hole closure rates.…”

Secondary macular holes: when to jump in and when to stay out

“…Unusually poor visual acuity signals co-existent pathologies like traumatic optic neuropathy: the optic nerve head appears deceptively normal early on, when the surgeon has to take a call on surgical prognosis [60]. When the morphology of SMH is similar to that of an idiopathic macular hole (round hole with edematous, not atrophic or irregular edges), the surgical outcomes are also likely to be similarly gratifying (FIGURE 1) [44,61]. This explains, at least to some extent, good outcomes in some SMHs [44,62] and poor results in similar etiologies by others [11,45].…”

“…Probably the two most important prognostic variables for the surgical decision-making are the morphology of SMH and preoperative visual acuity [11,44,45,61,62]. The best-case scenario is a visual loss fully explained by the morphology of SMH.…”

“…The duration of macular hole is less important now with greater surgical sophistication, especially ILM peeling [1]. Additional prognostic factors in SMH include the severity of causative/background pathology, concomitant lesions, time of presentation in relation to causative pathology, systemic status and patient compliance [11,12,21,34,37,44,45,57,[60][61][62][63][64]. Besides the above riders, SMHs (e.g., traumatic) are frequently larger than idiopathic macular holes [65].…”