United Kingdom National Ophthalmology Database study of vitreoretinal surgery: report 2, macular hole

Ophthalmology. 2013 Mar;120(3):629-634. doi: 10.1016/j.ophtha.2012.09.003. Epub 2012 Dec 1.


Purpose: To study macular hole (MH) surgery in terms of baseline demographics, intraoperative complications, post-vitrectomy cataract, reoperation, and visual outcome.

Design: National Ophthalmology Database study.

Participants: A total of 1078 eyes from 1045 patients undergoing primary MH surgery.

Methods: Participating centers prospectively collected clinical data using a single electronic medical record (EMR) system, with automatic extraction of anonymized data to a national database, over 8 years. The following data were extracted for eyes undergoing MH surgery: demographics, procedure elements, intraoperative complications, visual acuity (VA), and further surgery.

Main outcome measures: Description of the primary procedures performed, intraoperative complication rate, change in VA, proportion of eyes undergoing subsequent surgery for persisting MH, cataract, or retinal detachment.

Results: The median age was 70.3 years, with a 2.2:1 female preponderance. All operations included a pars plana vitrectomy (PPV)-41.1% with hexafluoroethane (C2F6), 25.6% with perfluoropropane (C3F8), 24.5% with sulfahexafluoride (SF6), 2.2% with air, and 0.4% with silicone oil. A PPV was combined with internal limiting membrane (ILM) peel in 94.1% and cataract surgery in 40.5%. One or more intraoperative complications occurred in 12.4%. The median presenting logarithm of the minimum angle of resolution (logMAR) VA improved from 0.80 to 0.50 after a median follow-up of 0.6 years; 57.8% of eyes improved ≥0.30 logMAR units (∼2 Snellen lines). The choice of gas tamponade did not significantly influence the visual outcome, but eyes undergoing ILM peel were significantly more likely to gain ≥0.30 logMAR units, as were eyes with poor presenting VA. Subsequently, 4.2% of eyes underwent repeat surgery for MH and 2.4% for retinal detachment, and, excluding pseudophakic eyes, 64.6% underwent cataract surgery within 1 year.

Conclusions: This study provides pooled, anonymized data on the demographics, complications, and visual outcome of MH surgery. This may enable vitreoretinal surgeons to benchmark their case-mix and outcomes, and facilitate risk-benefit and cost-benefit analyses.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Databases, Factual / statistics & numerical data*
  • Electronic Health Records
  • Endotamponade
  • Female
  • Fluorocarbons / administration & dosage
  • Humans
  • Intraoperative Complications
  • Male
  • Middle Aged
  • Ophthalmology / statistics & numerical data*
  • Postoperative Complications
  • Prospective Studies
  • Reoperation
  • Retinal Perforations / epidemiology
  • Retinal Perforations / surgery*
  • Sulfur Hexafluoride / administration & dosage
  • United Kingdom / epidemiology
  • Visual Acuity / physiology
  • Vitrectomy
  • Vitreoretinal Surgery / statistics & numerical data*
  • Young Adult


  • Fluorocarbons
  • perfluoroethane
  • perflutren
  • Sulfur Hexafluoride