Original article
Macular Hole Surgery and Cataract Extraction: Combined vs Consecutive Surgery

https://doi.org/10.1016/j.ajo.2010.04.008Get rights and content

Purpose

To compare the functional and the anatomic outcomes of a combined surgery and consecutive surgery for macular hole and cataract extraction.

Design

Multicenter, retrospective, comparative case series.

Patients

One hundred twenty patients (120 eyes) with an idiopathic macular hole and cataract were operated on in 1 or 2 sessions in 2 academic centers, Dijon University Hospital and Nancy University Hospital. Combined surgery (n = 64) and consecutive surgery (n = 56) were performed between 2006 and 2007. All patients underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade. Cataract extraction was performed with phacoemulsification followed by a posterior chamber intraocular lens implantation. The main outcome measures were near and far visual acuity at 6 and 12 months, and the rate of closure of macular hole evaluated with optical coherence tomography.

Results

After a 12-month follow-up, the postoperative best-corrected visual acuities significantly improved in both the combined and the consecutive surgery groups (near and far vision in both groups, P < .0001). However the improvement of far visual acuity was not significant in the consecutive surgery group at 6 months (P = .06) while such an improvement was observed in the combined surgery group (P < .0001). The rates of closure, 100% and 96% in the combined and the consecutive groups respectively, and the complications did not differ significantly between groups.

Conclusion

Both combined and consecutive surgeries are safe and effective methods to treat macular hole and cataract with equivalent functional and anatomic results in both procedures. However, combined surgery shortened the delay for visual recovery.

Section snippets

Material and Methods

A retrospective nonrandomized clinical case series study collected data on 120 consecutive eyes of 120 patients undergoing macular surgery in 2 academic centers between January 2, 2006 and December 31, 2007. The surgical indication was stage 2, 3, or 4 idiopathic macular hole according to the Gass classification and confirmed by optical coherence tomography (OCT).12 All patients had symptomatic visual loss and needed vitrectomy for macular hole treatment. All patients consented to surgery after

Results

Far and near visual acuities improved significantly in both groups at 12 months (P < .0001). The 6-month postoperative BCVA significantly improved in the combined group (P < .0001) but not in the consecutive group (P = .06). BCVA improvement was significantly different between the 2 groups at 6 months (P < .0001), whereas it was no longer significant at 12 months (P = .36) (FIGURE 1, FIGURE 2). Indeed, the progression of the BCVA during the first year after macular hole surgery was different in

Discussion

According to the literature, both combined and consecutive surgeries are safe and effective methods to treat macular hole and cataract.13 A number of authors have progressively tried to define the best surgical procedure to achieve a closure rate better than 90%.14, 15 In the present series, consecutive and combined surgeries for macular hole and cataract extraction resulted in an improvement in visual acuity similar to that usually reported in the literature.13, 16, 17, 18, 19, 20

The most

References (31)

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