First failed macular hole surgery or reopening of a previously closed hole: Do we gain by reoperating? ‐ A systematic review and meta‐analysis

Gerard A. Reid, Niamh McDonagh, David Wright, John T.O. Yek, Rohan W Essex, Noemi Lois

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Abstract

Purpose: To evaluate repeated surgery for idiopathic full-thickness macular hole that
failed to close (FTC) after first surgery or reopened (RO) once originally closed.
Methods: Systematic review and meta-analysis. Pubmed.gov and Cochrane Library
were searched for studies in English presenting outcomes of idiopathic full-thickness macular hole that FTC or RO (case reports/series of ,5 cases excluded).
Outcome Measures: Anatomical closure, postoperative best-corrected visual acuity,
intraoperative/postoperative complications, and patient-reported outcomes. Meta-analysis
was performed on aggregate and available individual participant data sets using the metafor package in R.
Results: Twenty-eight eligible studies were identified. After reoperation, pooled
estimates for anatomical closure were 78% (95% confidence interval 71–84%) and 80%
(95% confidence interval 66–89%) for FTC and RO groups, respectively. On average, bestcorrected visual acuity improved in both groups. However, only 15% (28 of 189 eyes) of FTC eyes achieved best-corrected visual acuity of $6/12. The pooled estimated probability of $2-line best-corrected visual acuity improvement was 58% in the FTC group (95%
confidence interval 45–71%); meta-analysis was not possible in the RO group. The most
common complication was cataract.
Conclusion: Reoperation for FTC or RO idiopathic full-thickness macular hole achieved
a clinically meaningful visual acuity improvement in more than half of patients; high levels of
vision ($6/12), however, were uncommon.
Original languageEnglish
Number of pages15
JournalRetina
Early online date22 Jul 2019
DOIs
Publication statusEarly online date - 22 Jul 2019

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