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Lookup NU author(s): Dr Declan Murphy, Dr Mo Al-Zubaidy, Professor David SteelORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2022 American Academy of OphthalmologyTopic: To define the effect of symptom duration on outcomes in people undergoing surgery for idiopathic full-thickness macular holes (iFTMHs) by means of an individual participant data (IPD) study of randomized controlled trials (RCTs). The outcomes assessed were primary iFTMH closure and postoperative best-corrected visual acuity (BCVA). Clinical Relevance: Idiopathic full-thickness macular holes are visually disabling with a prevalence of up to 0.5%. Untreated BCVA is typically reduced to 20/200. Surgery can close holes and improve vision. Symptom duration is thought to affect outcomes with surgery, but the effect is unclear. Methods: A systematic review identified eligible RCTs that included adults with iFTMH undergoing vitrectomy with gas tamponade in which symptom duration, primary iFTMH closure, and postoperative BCVA were recorded. Bibliographic databases were searched for articles published between 2000 and 2020. Individual participant data were requested from eligible studies. Results: Twenty eligible RCTs were identified. Data were requested from all studies and obtained from 12, representing 940 eyes in total. Median symptom duration was 6 months (interquartile range, 3–10). Primary closure was achieved in 81.5% of eyes. There was a linear relationship between predicted probability of closure and symptom duration. Multilevel logistic regression showed each additional month of duration was associated with 0.965 times lower odds of closure (95% confidence interval [CI], 0.935–0.996, P = 0.026). Internal limiting membrane (ILM) peeling, ILM flap use, better preoperative BCVA, face-down positioning, and smaller iFTMH size were associated with increased odds of primary closure. Median postoperative BCVA in eyes achieving primary closure was 0.48 logarithm of the minimum angle of resolution (logMAR) (20/60). Multilevel logistic regression showed for eyes achieving primary iFTMH closure, each additional month of symptom duration was associated with worsening BCVA by 0.008 logMAR units (95% CI, 0.005–0.011, P < 0.001) (i.e., ∼1 Early Treatment Diabetic Retinopathy Study letter loss per 2 months). ILM flaps, intraocular tamponade using long-acting gas, better preoperative BCVA, smaller iFTMH size, and phakic status were also associated with improved postoperative BCVA. Conclusions: Symptom duration was independently associated with both anatomic and visual outcomes in persons undergoing surgery for iFTMH. Time to surgery should be minimized and care pathways designed to enable this.
Author(s): Murphy DC, Al-Zubaidy M, Lois N, Scott N, Steel DH, Qu J, Zhao M, Sadda S, Manasa S, Agarwal D, Kumar A, Kakkar P, Bourgault S, Tourville E, Velez-Montoya R, Hernandez-Da Mota SE, Ramirez-Estudillo JA, Nawrocki J, Nawrocka ZA, Lange C, Bainbridge J, Yorston D, Alberti M, Cour ML, Christensen U, Ho Alvin KK
Publication type: Review
Publication status: Published
Journal: Ophthalmology
Year: 2023
Volume: 130
Issue: 2
Pages: 152-163
Print publication date: 01/02/2023
Online publication date: 02/09/2022
Acceptance date: 25/08/2022
ISSN (print): 0161-6420
ISSN (electronic): 1549-4713
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.ophtha.2022.08.028
DOI: 10.1016/j.ophtha.2022.08.028
PubMed id: 36058348
