Department of Ophthalmology, University of Catania, Catania, Italy.
Department of Ophthalmology, King's College Hospital, King's College London, London, UK.
Acta Ophthalmol. 2021 May;99(3):e324-e329. doi: 10.1111/aos.14575. Epub 2020 Aug 24.
To assess the incidence of normal vision following anatomically successful macular hole surgery and associated clinical variables.
Multicentre, retrospective chart review. Preoperative, intraoperative and postoperative clinical data were extracted from electronic medical records from seven European vitreoretinal units. Inclusion criteria were as follows: eyes undergoing primary vitrectomy for idiopathic full-thickness macular hole from January 2015 to January 2018; postoperative macular hole closure confirmed by spectral domain optical coherence tomography (OCT); preoperative pseudophakia or phakic eyes receiving combined cataract surgery; one-year follow-up. The primary outcome was 'normal vision' defined as a final best-corrected visual acuity (BCVA) ≥ 20/25. Univariate, multivariate and decision-tree analyses were conducted to evaluate the clinical variables associated with 'normal vision'. Odds ratios (OR) and confidence intervals (CIs) were calculated.
Of 327 eligible cases, 91 (27.8%) achieved 'normal vision' at 1 year. Multivariate analysis identified variables significantly associated with 'normal vision': shorter symptom duration (odds ratio [OR]=1.05; 95% confidence interval [CI]:1.02-1.09; p = 0.002), smaller preoperative OCT minimum linear diameter (OR per 100-micron increase = 1.65; 95%CI:1.31-2.08; p < 0.001) and better mean preoperative BCVA (OR = 15.13; 95%CI: 3.59-63.65; p < 0.001). The decision-tree analysis found that the most significant variable associated with 'normal vision' was symptom duration. 'Normal vision' was achieved in 70.6% of eyes operated within one week from symptom onset and in 45% of eyes with symptom duration between 1 and 3 weeks.
These findings suggested urgent surgery is justified for small macular holes of short duration.
评估解剖成功的黄斑裂孔手术后正常视力的发生率及相关临床变量。
多中心回顾性图表审查。从 7 个欧洲玻璃体视网膜单位的电子病历中提取术前、术中及术后临床数据。纳入标准如下：2015 年 1 月至 2018 年 1 月接受原发性玻璃体切除术治疗特发性全层黄斑裂孔的眼；术后黄斑裂孔闭合通过光谱域光学相干断层扫描（OCT）证实；术前白内障或晶状体眼接受联合白内障手术；随访 1 年。主要结果是“正常视力”，定义为最终最佳矫正视力（BCVA）≥20/25。进行单变量、多变量和决策树分析，以评估与“正常视力”相关的临床变量。计算比值比（OR）和置信区间（CI）。
在 327 例符合条件的病例中，91 例（27.8%）在 1 年后达到“正常视力”。多变量分析确定与“正常视力”显著相关的变量：症状持续时间较短（OR=1.05；95%CI：1.02-1.09；p=0.002），术前 OCT 最小线性直径较小（每增加 100 微米的 OR 增加 1.65；95%CI：1.31-2.08；p<0.001），术前平均 BCVA 较好（OR=15.13；95%CI：3.59-63.65；p<0.001）。决策树分析发现与“正常视力”最显著相关的变量是症状持续时间。在症状发作后 1 周内手术的眼，“正常视力”的发生率为 70.6%，症状持续时间在 1 至 3 周的眼，“正常视力”的发生率为 45%。
这些发现表明，对于持续时间短的小黄斑裂孔，应进行紧急手术。
