While the incidence of macular holes is relatively low, full-thickness defects can lead to vision loss. A recent study out of the United Kingdom found that females undergoing primary macular hole surgery tend to be younger and have larger macular holes than males. The investigators also suggested the definition of a large macular hole be changed to around 500μm.

The database investigation included 1,483 primary macular hole operations treated with a vitrectomy and a gas or air tamponade.

The researchers reported that a higher proportion of operations were performed in younger females (71%) who had slightly larger macular holes than their male counterparts.

Out of the 1,253 operations with a known surgical outcome, successful hole closure was achieved in 96% of cases. These positive outcomes were influenced by smaller holes and complete ILM peeling but not post-surgical positioning, the investigators explained.

Another key finding: a minimum linear diameter of about 500μm marked the threshold where the success rate started to decline.

Out of the 1,056 successfully closed operations, visual success (visual acuity of 0.30 logMAR or better) was achieved in roughly 46% of cases. Factors that predicted visual success included better pre-operative VA, smaller hole size, shorter duration of symptoms and the absence of AMD.

Patients with macular holes should be operated on early to help achieve good postoperative VA, the researchers suggested.

Steele DH, Donachie PHJ, Aylward GW, et al. Factors affecting anatomical and visual outcome after macular hole surgery: findings from a large prospective UK cohort. Eye (Lond). 2021;35(1):316-25.