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Eye (2005) 19, 879884
& 2005 Nature Publishing Group All rights reserved 0950-222X/05 $30.00www.nature.com/eyePD Jaycock1, C Bunce2, W Xing2, D Thomas1,W Poon1, G Gazzard3, TH Williamson1 andDAH Laidlaw1Outcomes of
macular hole
surgery: implications
for surgical
management and
clinical governanceCLINICALSTUDYAbstractPurpose The optimal method and timing ofthe surgical treatment for idiopathic macularholes remains unknown. The aim of thisretrospective study was to identify factorsassociated with anatomical and visual successin macular hole surgery.Methods Case records of 55 patientsundergoing macular hole surgery at threeunits in the 2-year period up to July 2002 werereviewed to identify factors associated withanatomical and visual success. The followingpotential prognosticators were evaluated:patient age, hole stage, hole latency prior tosurgery, preoperative acuity, simultaneousphacoemulsification, and intraocular lensimplantation, internal limiting membranepeeling with and/or without indocyaninegreen, and postoperative posturing.Results The duration of preoperativesymptoms, indocyanine green-assistedinternal limiting membrane peeling, holestage, and better preoperative visual acuitywere associated with both anatomical successand regaining a postoperative visual acuity of6/12 or better.Discussion The closure rate in patientsundergoing surgery within 1 year of onsetwas 94.0%, and in those waiting 1 year ormore it was 47.4%. Clinical governance andquality issues should dictate that NHSmacular hole surgery is available to allwithin 1 year of onset. This study showed noadverse effect of ICG dye retinal staining.The results support the use of a patientfriendly approach of simultaneous cataractsurgery with no prone postoperativeposturing.Eye (2005) 19, 879884. doi:10.1038/sj.eye.6701679;published online 24 September 2004Keywords: macular hole; audit; clinicalgovernance; duration; ICG; ILMIntroductionThe aim of this retrospective study was toidentify factors associated with anatomical andvisual success in macular hole surgery. Theoptimal method and timing of the surgicaltreatment for idiopathic macular holes remainunknown. The traditional technique has beento perform a vitrectomy, induce a posteriorvitreous detachment, instil a long-acting gastamponade and require the patient to posturein a prone position for up to 2 weeks. Morerecently it has been suggested that proneposturing may not be required and shorteracting tamponade agents have also been used.1The recent increase in use of preoperativeinternal limiting membrane (ILM) peelinghas been associated with an increased rateof success in macular hole surgery.2 Thismanoeuvre is greatly facilitated by the useof indocyanine green (ICG) dye;3 there are,however, reports of adverse functional outcomewhen this dye has been used.410 Nuclearsclerotic cataract is a very common complicationof macular hole surgery, as a consequence ofwhich some surgeons perform simultaneousprophylactic clear lens extraction...