VITRECTOMY STUDY

Vitrectomy for macular hole and epiretinal membrane (ERM) is a safe procedure with excellent five-year visual results in elderly patients, according to the results of a new Irish study presented at the 2015 Irish College of Ophthalmologists annual conference in Westport, Ireland.

Vitrectomy for macular hole and ERM accounts for approximately 20 per cent of all vitreoretinal surgery, according to UK data.

However, some recent studies have demonstrated a negative long-term impact of inner limiting membrane peeling in macular hole surgery, while other studies have shown a continued improving benefit in ERM surgery over five years, noted Sinead Connolly MD, Mater Hospital, Dublin, Ireland.

The Irish study looked at the long-term visual and anatomic results following vitrectomy for macular hole and ERM in a single Irish centre under a single surgeon (2007-2010).

The study assessed the results of 75 eyes in 64 patients. Some 46 eyes were treated for macular hole, 26 for ERM and three for vitreomacular traction. Seven patients underwent combined phaco and vitrectomy.

Of the 63 phakic patients, 10 underwent combined phacoemulsification, lens implantation and pars plana vitrectomy (PPV), and a further 35 underwent subsequent cataract surgery during the five-year follow up.

VISUAL ACUITY

A total of 69 per cent of eyes with macular hole, 68 per cent of eyes with ERM and 100 per cent of eyes that underwent vitrectomy had improved visual acuity from baseline.

“The visual acuity improvement was significant, with 60 per cent of the macular hole patients achieving a visual acuity of 6/12 at five years out. These patients were in their late 70s and 80s and this meant that they were still able to meet driving criteria and go to the shops,” Dr Connolly told the meeting.

Meanwhile, she reported that the macular hole primary closure rate was 93.1 per cent (41 out of 44 eyes). Of the three eyes that did not attain primary closure after the first surgery, two of them were large holes; >600 microns.

NO COMPLICATIONS

The vast majority (88 per cent) of patients experienced no complications and recovered well, she said. The most common complication was iatrogenic retinal breaks, in eight eyes (10.67 per cent). One patient was treated for a retinal detachment 10 months post surgery, but had been classed as an at-risk patient, she noted.

Dr Connolly said the Irish study results were very positive and in line with similar international studies.

The Irish study now hopes to collaborate with the Amsterdam Medical Centre to increase the study numbers in order to publish the results.

Sinead Connolly: connolsi@tcd.ie