Impact of time to surgery on post-operative visual acuity in patients with full-thickness macular hole repair (FTMH)

Authors: Sumana C. Naidu , Josh Herman, Isabela Martins Melo, Milena Cioana, Mariam Mohammed Issa, Hesham Hamli, Rajeev H. Muni.  University of Toronto.

Author Disclosures: S.C. Naidu:   None.  J. Herman:   None.  I. Martins Melo:   None.  M. Cioana:   None.  M. Mohammed Issa:   None.  H. Hamli:   None.  R.H. Muni:   None.

Abstract Body: 

Purpose:   Assess impact of time to surgery on post-operative visual acuity (VA) in patients with full-thickness macular hole (FTMH), adjusting for spectral-domain optical coherence tomography (SD-OCT) parameters.       

Study Design:   Retrospective case series.   

Methods:   Retrospective study including eyes with FTMH undergoing pars plana vitrectomy (PPV) at our centre with internal limiting membrane peeling. Primary outcome was effect of time to surgery on last follow-up VA. Clinicodemographic variables and preoperative SD-OCT parameters, including vitreomacular adhesions (VMA), cystic changes, and minimum linear width (MLW) of the hole were collected. Multivariate regression was used to explore factors impacting VA in the first year post-operative period, including an analysis of cases with available preoperative SD-OCT data.   

Results:   317 patients were included. Multiple linear regression including all cases and controlling for age (median 67), sex (63% female), time to PPV (99 ± 110 days), pre-operative VA (0.85 ± 0.35), timepoint of last follow up (248 ± 140 days, median 63; IQR 90), and presence of cataracts at last follow up (27%), showed no significant impact of time to surgery on post-operative VA at last follow-up (p=0.98). Sub-analysis of 145 patients with VA at 1 year post-operatively, does not show a significant relationship to time to PPV (p=0.33). Multivariate regression controlling for: age (median 68), sex (61% female), pre-op VA (0.86± 0.35), and timepoint of last follow up (246 ± 136 days), investigated the impact of time to PPV (98±115, median 61, IQR (30-11.25), pre-operative VMA (21%), pre-operative cystic changes (91%) and macular hole minimum linear width (376±189 um) on post-operative VA at last timepoint among 246 patients with pre-operative SD-OCT data. There was no significant impact of time to PPV (p=0.77) on VA in our model (F=5.79, Adj R²=0.15), although pre-operative VA (p<0.001) and larger minimum linear width (p=0.003) were significantly associated with worse post-operative VA.   

Conclusions:   There was no evidence that delays to PPV were associated with worse post-operative VA in the year following surgery. Pre-operative VA and macular hole size are strong prognostic variables for post-operative VA after PPV for FTMH repair.