Retreatment of full-thickness macular hole: predictive value of optical coherence tomography

Aim: To determine whether the efficacy of re-operation for idiopathic full-thickness macular hole (FTMH) remaining open after initial surgery with internal limiting membrane (ILM) peeling is correlated with macular hole configuration as determined by optical coherence tomography (OCT), macular hole size, macular hole duration before the first operation, or type of tamponade ( gas or silicone oil). Methods: A retrospective consecutive interventional case series of 28 patients (28 eyes) with a persisting macular hole after vitrectomy, ILM peel, and gas tamponade. 28 patients underwent repeat surgery involving vitrectomy and gas (n=15) or silicone oil tamponade (n=12) or no tamponade (n=1). Autologous platelet concentrate (n=22), autologous whole blood ( n=1), or no adjuvant (n=5) was used. Preoperative OCT was undertaken in all eyes. The main outcome measures were anatomical closure and improvement of best-corrected visual acuity (BCVA). Results: Anatomical closure was achieved in 19 of 28 eyes (68%). BCVA improved in 12 eyes, remained unchanged in nine, and worsened in seven. BCVA improved in 11 of 19 eyes with anatomical closure, and in one of eight eyes without closure. Anatomical closure and improvement of BCVA correlated with preoperative macular hole configuration on OCT, with higher rates of closure ( 18 of 20 eyes versus one of eight eyes, p=0.001) and greater improvement of BCVA (p=0.048) in eyes with a cuff of subretinal fluid at the break margin. Macular hole size, type of tamponade, macular hole duration before the first operation, or preoperative BCVA did not significantly correlate with visual or anatomical outcome. Conclusion: Macular hole configuration seems to be a strong prognostic indicator of anatomical closure and may help identify those patients most likely to benefit from re-operation.