Macular hole surgery: an analysis of risk factors for the anatomical and functional outcomes with a special emphasis on the experience of the surgeon

Figures & data

Table 1 Demographic and clinical patient characteristics

Characteristics	Years of previous experience in vitreoretinal surgery					P-value
	All (n=225)	0–3 years (n=43)	4 years (n=41)	5 years (n=44)	≥6 years (n=97)
Age (years)	70 (SD=7)	70 (SD=7)	70 (SD=5)	70 (SD=7)	69 (SD=7)	0.822A
Gender (male), n (%)	73 (32)	10 (23)	12 (29)	16 (36)	35 (36)	0.434C
Side, n (%)
Left	112 (50)	19 (44)	18 (44)	24 (54.5)	51 (53)	0.613C
Right	113 (50)	24 (56)	23 (56)	20 (46.5)	46 (47)
Stage of macular hole*, n (%)
II	117 (52)	23 (54)	21 (51)	17 (39)	56 (58)	0.292C
III	72 (32)	13 (30)	15 (37)	15 (34)	29 (30)
IV	36 (16)	7 (16)	5 (12)	12 (27)	12 (12)
Maximum size of hole (µm)	381 (SD=168)	418 (SD=190)	385 (SD=145)	432 (SD=163)	340 (SD=161)	0.007A
Lens status, n (%)
Phakic	181 (80)	34 (79)	32 (78)	38 (86)	77 (79)	0.741C
Pseudophakic	44 (20)	9 (21)	9 (22)	6 (14)	20 (21)
Epiretinal membrane (OCT), n (%)	36 (16)	3 (7)	9 (22)	8 (18)	16 (17)	0.277C
Visual acuity before surgery (log MAR)	0.84 (SD=0.29)	0.9 (SD=0.28)	0.87 (SD=0.3)	0.9 (SD=0.27)	0.78 (SD=0.3)	0.041A

Notes: Data are presented as n (%) or mean (SD).

A Represents ANCOVA,

C represents Pearson’s chi-squared test.

* Classification according to Gass.³⁰

Abbreviations: ANCOVA, analysis of covariance; log MAR, logarithm of the minimum angle of resolution; MH, macular hole; OCT, optical coherence tomography; SD, standard deviation.

Table 2 Surgery and complications

	All (n=225)	0–3 years (n=43)	4 years (n=41)	5 years (n=44)	≥6 years (n=97)
Follow-up (months)	20.5 (SD=19)	32 (SD=23)	22 (SD=19)	14 (SD=12)	24 (SD=18)
Operation time (minutes)	63 (SD=19)	76 (SD=18)	70 (SD=19)	66 (SD=19)	53 (SD=14)
Dye, n (%)
ICG	116 (52)	43 (100)	15 (37)	9 (20.5)	49 (50.5)
BBG	109 (48)	0	26 (63)	35 (79.5)	48 (49.5)
Incision size, n (%)
20 G	177 (79)	43 (100)	31 (76)	24 (54.5)	79 (81)
23 G	48 (21)	0	10 (24)	20 (45.5)	18 (19)
Tamponade, n (%)
SF6	38 (17)	15 (35)	5 (12)	1 (2)	17 (18)
C2F6	33 (15)	8 (19)	4 (10)	8 (18)	13 (13)
C3F8	154 (68)	20 (47)	32 (78)	35 (80)	67 (69)
Postoperative retinal detachment, n (%)	8 (4)	3 (7)	3 (7)	0	2 (2)
Kryocoagulation/laser retinopexy applied, n (%)	96 (43)	15 (35)	22 (54)	24 (55)	35 (36)
Persistent macular edema, n (%)	4 (1.8)	1 (2.3)	1 (2.4)	1 (2.3)	1 (1)
Infection, reopening, iatrogenic MH, n (%)	0 (0)	0 (0)	0 (0)	0 (0)	0 (0)

Note: Data are presented as n (%) or mean (SD).

Abbreviations: BBG, brilliant blue G; ICG, indocyanine green; MH, macular hole; SD, standard deviation.

Table 3 Multivariable logistic regression models on MH closure

	n	MH closure	No MH closure	OR (95% CI)	P-value
Experience
0–3 years	43	36 (84%)	7 (16%)	Reference category
4 years	41	35 (85%)	6 (15%)	1.23 (0.31, 4.82)	0.768
5 years	44	36 (82%)	8 (18%)	1.02 (0.28, 3.74)	0.976
≥6 years	97	87 (90%)	10 (10%)	1.00 (0.29, 3.43)	0.993
Size MH	225	351	569	2.36 (1.71, 3.25)a	<0.001
		(SD=145)	(SD=184)

Notes: Data are presented as n (%) or mean (SD).

a Per 100 µm. The odds ratio of each experience level refers to the reference category 0–3 years.

Abbreviations: CI, confidence interval; MH, macular hole; OR, odds ratio; SD, standard deviation.

Table 4 Change of visual acuity after surgery (pre-log MAR–postlog MAR)

	n	Meana (95% CI)	P-value vs reference
Experience
0–3 years	37	0.27 (0.18, 0.37)	Reference
4 years	37	0.38 (0.28, 0.48)	0.144
5 years	39	0.43 (0.31, 0.56)	0.052
≥6 years	89	0.43 (0.37, 0.49)	0.009

Note:

a Estimated marginal mean and 95% CI using an ANCOVA adjusted by preoperative visual acuity, size of MH, follow-up time and dye.

Abbreviations: ANCOVA, analysis of covariance; CI, confidence interval; log MAR, logarithm of the minimum angle of resolution; MH, macular hole.

Table 5 Multivariable logistic regression on restoration of macular structure (n=164)

	n	Restoration	No restoration	OR (95% CI)	P-value
Experience
0–3 years	24	7 (29%)	17 (71%)	Reference category
4 years	33	21 (64%)	12 (36%)	0.34 (0.09, 1.28)	0.110
5 years	39	26 (67%)	13 (33%)	0.16 (0.04, 0.61)	0.007
≥6 years	68	38 (56%)	30 (44%)	0.70 (0.21, 2.28)	0.548
Size MH	164	325 (SD=136)	506 (SD=164)	2.76 (1.95, 3.89)a	<0.001

Notes: Data are presented as n (%) or mean (SD).

a Per 100 µm. The odds ratio of each experience level refers to the reference category 0–3 years.

Abbreviations: CI, confidence interval; OR, odds ratio; SD, standard deviation; MH, macular hole.

GassJDReappraisal of biomicroscopic classification of stages of development of macular holeAm J Ophthalmol199511967527597785690

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