Vitreous surgery for idiopathic macular holes stage 2 and 3.: Results and prognostic factors

Purpose: To determine prognostic factors, functional outcome and subjective rating after surgery for macular holes stage 2 and 3. Methods: We studied 53 eyes of 49 patients undergoing vitreous surgery for macular holes stage 2 (46%) and 3 (54%). Mean follow-op was 114 weeks (32-204, std.dev. +/-48), mean age 68,9 years (44-89, std.dev. +/-6,8). 72% were female. 11% were pseudophakic, 19 % phakic, 70% had a combined procedure (pars plana vitrectomy, phakoemulsification and IOL). Surgery consisted in a pars plana vitrectomy, peeling of epiretinal membranes and ILM, internal tamponade with SF6 (98%) resp. Si-oil in one case. Patients had to keep face-down position 6 x 20 minutes per day. Results: The hole was completely closed in 90,6%. Anatomical failures included, 86% had an increase of VA, 41% = 5 lines (Final VA median 20/30, max. 20/20). No further increase of the retinal function occurred after 6 months. The visual result did not correlate with the duration of symptoms. 84% were satisfied with the outcome, subjective rating was not correlated with final VA or change of VA. 19% showed postoperative typical peripheral visual field defects. Visual field loss was not correlated with perioperative IOP elevation. Conclusion: Macular hole surgery has a high functional success rate. Postoperative visual field defects are an important problem.