Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography

Am J Ophthalmol. 2011 Jan;151(1):118-127.e1. doi: 10.1016/j.ajo.2010.07.007.


Purpose: To use spectral-domain optical coherence tomography (SD OCT) to evaluate macular hole surgery outcomes and features predicting anatomic failure.

Design: Retrospective, interventional case series.

Methods: Fifty-two eyes of 50 consecutive patients with macular holes were examined. All eyes underwent 3-port pars plana vitrectomy with internal limiting membrane peeling. Eyes were examined after surgery by dense serial SD OCT scanning over the macula.

Results: Eyes with initial anatomic failure were significantly more likely to have greater axial length and refractive error and more posterior staphyloma compared with eyes with initial anatomic success (P = .031 to .0060, < .0001). Overall initial and final anatomic success rates were 92.3% (48 of 52 eyes). In highly myopic eyes with axial lengths of 26.0 mm or more, initial and final success rates were 73.3% (11 of 15 eyes) compared with 100.0% (37 of 37 eyes) of eyes with axial lengths of less than 26.0 mm (P = .0050). In highly myopic eyes, initial and final success rates were 0% (0 of 3 eyes) of eyes with axial lengths of 30.0 mm or more compared with 91.7% (11 of 12 eyes) of eyes with axial lengths of 26.0 mm or more and of less than 30.0 mm (P < .0001). Retinoschisis-like thickening of the outer retina was seen in 3 (75.0%) of 4 eyes with initial failure compared with 3 (6.3%) of 48 eyes with initial success (P = .0030).

Conclusions: Axial length of 30.0 mm or more may increase the risk of anatomic failure of macular hole surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Axial Length, Eye / pathology*
  • Basement Membrane / surgery
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prone Position
  • Retinal Perforations / diagnosis*
  • Retinal Perforations / surgery*
  • Retrospective Studies
  • Tomography, Optical Coherence*
  • Tonometry, Ocular
  • Treatment Outcome
  • Visual Acuity / physiology
  • Vitrectomy*