Long-term Follow up of Visual Functions after Anatomical Successful IdiopathicMacular Hole Surgery

Overview

Purpose:
The purpose of the study is to determine the outcomes of long-termchanges and evolution of visual acuity in patients undergoing anatomicallysuccessful macular hole surgery.Materials and methods: Into prospective study are enrolled 20 eyes (20 patients).All patients were successfully operated for idiopathic macular hole betweenSeptember, 1996 and August, 1998. Time of follow up ranged from 20 to 43 months(mean, 29,5). The best corrected visual acuity was examined before operation andevery 3 months after surgery. 12 eyes were operated for complicated cataract. Thesubgroup of 16 eyes wasselected fromthe groupof 20 eyes. Thesubgroupconsistedof patients, who in the first examination observed in Watzke-Allen test theinterruption of ray of light and there was a central scotoma on the campimetry.These tests were realised before operation and in the 3rd, 9th and 15th monthsafter operation. Fisher's test and Student's t test were used for statistical analysis.Results: Mean corrected visual acuity before operation was 0,21. Best correctedvisual acuity was 0,44, reached in the 12th months. Improvement in +2 or morelines wasreachedin 55%. In 15th and18th months the meancorrectedvisual acuitydecrease because of the progression of nuclear sclerosis. 12 eyes were operatedfor complicated cataract. Thebest correctedvisual acuity before andafter surgeryof idiopathic macular hole was 0,18 respectively 0,39 and improvement in +2 ormore lines was reached in 6 (50%) eyes. After surgery of complicated cataract themeanvisual acuity was 0,49. Futher improvement in +2 or morelines wasreachedin 2 (16,7%) eyes, together in 8 (66,%) eyes. Statistical analysis (Fischer's tests,Student's t test) was significant (P < 0,05).In the subgroup of 16 eyes, where were followed changes in Watzke-Allen test, theinterruption of ray of light was in all 16 (100%) patients. In the 3rd month 6 (37,5%)patients observed interruption of ray of light and other 10 (62,5%) observeddeformation in the central part of ray of light. In 9th and 15th months theinterruption observed 5 (31,25%) patients. Deformation in 9th and 15th monthsobserved 8 (50%) respectively 5 (31,25%) patients.Gradual decrease of central scotoma observed in the 3rd, 9th and 15th month 10(62,5%), 13(81,25%)and14(87,5%)patients. Duringthefollowupin 12(75%)patientswas reached total disappearence of central scotoma.Conclusions: The evolution of visual acuity after anatomically successful surgeryof idiopathic macular hole is dynamic, long-standing and continual process.Improvement of visual acuity can be masked by progression of complicatedcataract - nuclear sclerosis. Futher improvement of visual acuity can be observedafter of the surgery complicated cataract.

Key words:
idiopathic macular hole, pars plana vitrectomy, visual acuity, campi-metry