Materiały źródłowe

• #1 Outcomes of Vitrectomy for Long-Duration Macular Hole

  https://www.mdpi.com/2077-0383/9/2/444

  The present study investigated the functional and anatomical outcomes of idiopathic chronic macular hole (MH) surgery with different surgical approaches related to the chronicity and diameter of the MH. […] Patients with chronic MH and ERM have worse functional and anatomical outcomes after surgery. Treatment of chronic MHs without ERM results in a better closure rate with either an inverted ILM flap approach or systematic ILM peel. […] The outcomes of surgery are worse, depending on the duration of the hole and its diameter. […] Most studies demonstrate clear benefits if surgery is performed within six months of the onset of symptoms, and suggest an inverse relationship between the duration of symptoms of FTMH and surgical success in terms of closure and visual acuity improvement. […] This study shows that patients with chronic MH and the main duration of symptoms of 13.5 months can gain both anatomical and functional success from ILM peeling or inverted ILM flap technique surgery, while the presence of ERM with MH has a worse hole closure rate.

• #2

  https://link.springer.com/article/10.1007/s00417-024-06500-2

  To identify optical coherence tomography (OCT) parameters that predict postoperative best corrected visual acuity (BCVA) and are based on recent understanding of the pathomechanism of idiopathic full thickness macular hole (iFTMH) formation and closure. […] Our study suggests that MHI and B can be useful predictors of short term BCVA while the new A/B index that incorporates OCT parameters indicating potential preoperative photoreceptor damage may be a good predictor for long term postoperative BCVA. Our findings support the theory that initial hole formation mechanisms and photoreceptor damage define visual prognosis. […] Since postoperative vision of iFTMH patients varies widely, its prediction remains an important goal. […] This regeneration can take place even in the case of very large holes, where inward movement of PR outer segments and outward movement of the inner layers of the fovea was observed, similarly to the organization of foveal structures during retinal development.

• #3 Frequently assessed and used prognostic factors for outcome after macular hole surgery: which is better? | BMC Ophthalmology | Full Text

  https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-021-02164-2

  The aim of this retrospective study was to evaluate commonly used clinical and OCT-morphological parameters, including perifoveal pseudocysts, as prognostic factors for postoperative outcome after macular hole surgery in a retinal referral clinic in North Rhine-Westphalia, Germany. […] The overall closure rate was 86.8%. The mean best corrected VA increased from 0.70.3 logMAR before surgery to 0.50.3 logMAR (p 0.0001). […] The minimum linear diameter serves as an easily assessed prognostic factor with the best predictive properties. This result is of great importance for clinical practice, as it simplifies the postsurgical prognosis. […] The minimum linear diameter was the only parameter showing predictive properties in the regression analyses regarding both surgical and functional outcome. Thus, in our opinion, the results of this study show that there is no need for complicated measurements of the macular hole area or cyst areas or for the calculation of any indices. The minimum linear diameter serves as an easily assessed parameter with the best predictive properties. This result is of great importance for clinical practice, as it simplifies the postsurgical prognosis.

• #4 Macular Hole: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1224320-overview

  In 1994, Wendel reported a series of 235 consecutive eyes undergoing repair of macular holes. In this series, 93% of patients were successfully managed with only a single operation; 60% patients experienced 4+ lines of visual improvement; and 84% patients experienced 2+ lines of improvement. Within this group, 58% of patients achieved 20/40 or better final visual acuity. […] Multiple other studies cite similar success rates, though vision recovery may be protracted and also further delayed by onset of cataract formation. Use of ILM peeling may further increase the rate of single operation success, though it may potentially slow or affect final vision recovery. […] OCT imaging preoperatively and postoperatively has provided additional prognostic data for visual recovery following macular hole surgery. Factors on OCT predictive of good visual acuity macular hole surgical outcome are as follows: Size of macular hole (minimum diameter 311 m), Traction on macular hole edges as defined by various parameters (eg, macular hole height), Development of a normal photoreceptor inner segment and outer segment junction, which can occur as early as 1 month postoperatively but typically by 6 months postoperatively, The presence of an epiretinal membrane on OCT may be a poor prognostic sign for closure of a full thickness macular hole, The height of the external limiting membrane (ELM) on OCT has also been found to be predictive of postoperative visual acuity. […] While surgery for macular holes is considered elective, it is important for the patient to consider prognostically that there is potentially a risk for the fellow eye to develop a macular hole as well (12%).

• #5 Macular Hole

  https://www.asrs.org/patients/retinal-diseases/4/macular-hole

  Vitrectomy has a success rate of over 90%, with patients regaining some or most of their lost vision. […] In cases where the macular hole is very small and does not have a large impact on your vision, your doctor may not recommend any treatment at all. He or she may simply observe and track the macular holes progression or natural healing.

• #6 Frequently assessed and used prognostic factors for outcome after macular hole surgery: which is better?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8600723/

  The aim of this retrospective study was to evaluate commonly used clinical and OCT-morphological parameters, including perifoveal pseudocysts, as prognostic factors for postoperative outcome after macular hole surgery in a retinal referral clinic in North Rhine-Westphalia, Germany. […] The overall closure rate was 86.8%. The mean best corrected VA increased from 0.70.3 logMAR before surgery to 0.50.3 logMAR (p 0.0001). […] The minimum linear diameter serves as an easily assessed prognostic factor with the best predictive properties. This result is of great importance for clinical practice, as it simplifies the postsurgical prognosis. […] The minimum linear diameter was the only parameter showing predictive properties in both the linear and logistic regression analyses. […] The minimum linear diameter was a stronger predicator for postoperative VA than the basal diameter or the manually marked MH area.

• #7 Frequently assessed and used prognostic factors for outcome after macular hole surgery: which is better?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8600723/

  The receiver operating characteristic curve for surgical failure and MLD in their study reached an area under the curve (AUROC) of 77.9%; in our study, it reached 90.1%. […] The areas of parafoveal intraretinal pseudocysts were correlated in our study with a low closure rate and with low postoperative visual acuity. […] The minimum linear diameter was the strongest predictive factor for surgical success.

• #8

  https://link.springer.com/article/10.1007/s00417-024-06500-2

  Stepwise multiple logistic regression showed that long term BCVA was best predicted by B (base diameter) and A (smaller ELM-GCL distance as measured on the walls of the MH at its largest diameter), which also supports the above hypothesis. Based on these results, we established a new index, A/B. This index proved very efficient in the prediction of long-term visual acuity as shown by AU-ROC results. […] The significant AU-ROC values of A/B index indicate that it can predict long term BCVA not only in cases when vitreomacular tractional forces play a role in MH formation but also when atrophic processes contribute to the PR damage, as in atrophic lamellar holes, however, this proposition needs further investigation.

• #9 External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis | Eye

  https://www.nature.com/articles/eye2011237

  To investigate the relationship between postoperative visual acuity and integrity of the external limiting membrane (ELM) and inner segmentouter segment (ISOS) junction layers, using spectral domain optical coherence tomography (SD-OCT), in eyes with macular holes (MHs) following surgical repair. […] The integrity of the ELM layer appears to be a critical factor for the restoration of the photoreceptor layer and for predicting a successful visual outcome following MH repair. […] When both ELM and ISOS layers showed disruptions 6 weeks postoperatively, a significantly worse BCVA was measured at 6 months, compared with the eyes with only ISOS disruptions, detected 6 weeks following surgery. […] Our findings suggest that combined disruptions of the ELM and ISOS junction predict worse visual outcomes for MH repair than isolated ISOS disruptions.

• #10 External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis | Eye

  https://www.nature.com/articles/eye2011237

  The findings of this study highlight the discrepancy between the anatomical and functional success of macular surgery. […] The integrity of the ELM appears to be an essential ingredient for the eventual restoration of the ISOS layer and achievement of a favorable visual outcome following MH repair.

• #11 Cited

  https://www.koreamed.org/SearchBasic.php?RID=949058

  PURPOSE To identify the correlation between preoperative optical coherence tomography (OCT) features and postoperative visual outcomes in eyes with idiopathic macular holes (MHs). […] CONCLUSIONS The length and viability of detached photoreceptors are significant preoperative OCT features for predicting visual prognosis. This suggests that, regardless of the MH size and symptom duration, active surgical intervention should be encouraged, particularly if the MH exhibits good viability in the detached photoreceptor layer.

• #12 Cited

  https://www.koreamed.org/SearchBasic.php?RID=949058&DT=1

  PURPOSE To identify the correlation between preoperative optical coherence tomography (OCT) features and postoperative visual outcomes in eyes with idiopathic macular holes (MHs). […] RESULTS V(postop) was determined to be significantly correlated with the preoperative visual acuity (V(preop)) and OCT parameters A, C, and D (p […] CONCLUSIONS The length and viability of detached photoreceptors are significant preoperative OCT features for predicting visual prognosis. This suggests that, regardless of the MH size and symptom duration, active surgical intervention should be encouraged, particularly if the MH exhibits good viability in the detached photoreceptor layer.

• #13 Internal limiting membrane peel size and macular hole surgery outcome: a systematic review and individual participant data study of randomized controlled trials | Eye

  https://www.nature.com/articles/s41433-025-03666-9

  There is no consensus regarding the optimal internal limiting membrane (ILM) peel size during vitrectomy for idiopathic full thickness macular holes (iFTMH). […] Performing ILM peel of more than 1-DD in radius likely improves closure rates for iFTMH although the effect size is relatively small. The effect is greater in holes 400 microns. ILM peel size probably has no significant effect on postoperative VA. […] An ILM peel of more than 1-disc diameter in radius probably improves closure rates for full thickness macular hole as compared to smaller peel radii. The effect is small with a NNT to benefit of 31 for closure. The effect of visual acuity was also small with a mean gain of 0.05 logMAR. The effect was greater for holes greater than 400 microns in MLD where the NNT reduced to 21.

• #14 Development and validation of a deep learning system to classify aetiology and predict anatomical outcomes of macular hole | British Journal of Ophthalmology

  https://bjo.bmj.com/content/107/1/109

  Aims To develop a deep learning (DL) model for automatic classification of macular hole (MH) aetiology (idiopathic or secondary), and a multimodal deep fusion network (MDFN) model for reliable prediction of MH status (closed or open) at 1 month after vitrectomy and internal limiting membrane peeling (VILMP). […] Conclusion Our DL-based models can accurately classify the MH aetiology and predict the MH status after VILMP. These models would help ophthalmologists in diagnosis and surgical planning of MH. […] Since IMH is the most common type of MH, it is clinically important to predict the anatomical outcomes of IMH surgeries. Accurate prediction of the postoperative IMH status can alleviate patients’ anxieties and help ophthalmologists make better surgical plans. […] Our MDFN model contains two modules, feature extraction and feature fusion. Two types of IMH deep features were extracted, including features of the preoperative macular OCT images extracted by VGG network and features of the clinical data extracted by FC network. These two sets of features were fused by the MDFN model to predict MH status after VILMP. […] In conclusion, our DL-based models are highly accurate in classification of MH aetiology and prediction of postoperative MH/IMH status. The DL-based models are potentially useful to help make automatic diagnosis and better surgical planning for patients with MH.

• #15 Machine learning-based prediction of anatomical outcome after idiopathic macular hole surgery

  https://atm.amegroups.org/article/view/69995/html

  In the internal validation, the mean area under the receiver operating characteristic curves (AUCs) of the five ML algorithms were 0.8820.951. […] In the external validation, the AUC of RF was 0.940, with an accuracy of 0.875, a specificity of 0.875, and a sensitivity of 0.958. […] Therefore, ML models may help optimize surgical planning for IMH patients in the future. […] The RF algorithm (i.e., the best-performing algorithm) was further validated using an independent external validation set. […] Moreover, we identified that BASE is the most critical feature for an accurate prediction. […] The prediction of the postoperative IMH status could alleviate anxieties of patients and could help surgeons choose more radical surgical techniques, such as an inverted ILM flap and an autologous ILM transplantation, for patients with an unfavorable prognosis and refractory IMH.

• #16 Supervised machine learning statistical models for visual outcome prediction in macular hole surgery: a single-surgeon, standardized surgery study | International Journal of Retina and Vitreous | Full Text

  https://journalretinavitreous.biomedcentral.com/articles/10.1186/s40942-025-00630-3

  To evaluate the predictive accuracy of various machine learning (ML) statistical models in forecasting postoperative visual acuity (VA) outcomes following macular hole (MH) surgery using preoperative optical coherence tomography (OCT) parameters. […] Overall, 91% achieved MH closure post-surgery, with a median VA gain of -0.3 logMAR units. […] The model accurately predicted the post-operative VA within 0.1, 0.2 and 0.3 logMAR units in 61%, 78%, and 87% of OCT images, respectively. […] The RF regression model demonstrated superior predictive accuracy for forecasting postoperative VA, suggesting ML-driven approaches may improve surgical planning and patient counselling by providing reliable insights into expected visual outcomes based on pre-operative OCT features. […] The primary predictive factor was postoperative closed MH status. […] The RF model demonstrated predictive performance for VA, accurately forecasting VA within 0.1 logMAR units in 61% of cases, within 0.2 logMAR units in 78%, and within 0.3 logMAR units in 87%.

• #17 Machine learning-based prediction of anatomical outcome after idiopathic macular hole surgery

  https://atm.amegroups.org/article/view/69995/html

  These findings suggest that the size of IMH may be the most important parameter to determine the postoperative status. […] The best-performing ML model (using RF algorithm) identified that BASE is the most critical feature for the prediction of postoperative IMH status. […] The RF algorithm still showed an excellent performance due to its robustness and stability.

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