Introduction: Macular hole and cataract are pathologies that often occur simultaneously in elderly patients and lead to a progressive decrease in visual acuity and worsen metamorphopsia. The incidence of macular holes varies in different populations, with an average of about 3.3 per 1,000 people. It affects to a greater extent the female sex (F:M = 3:1), usually over sixty years. The causes of a macular hole are many, patients with high myopia are a risk group, trauma is a risk factor at any age, as well as the changes that occur with the vitreous body with age.
Aim: The present study aimed to evaluate the visual and anatomical outcomes as well as the quality of life of patients who underwent combined macular hole and cataract surgery.
Methods: In the present study, 20 patients diagnosed with macular hole and cataract were included, each patient underwent a complete ophthalmological examination with highly specialized equipment. The Early Treatment Diabetic Retinopathy Study (ETDRS) was used as the gold standard for visual acuity determination, and optical coherence tomography (OCT) was used for diagnosis, macular hole size determination, and postoperative follow-up of anatomical results. Patients underwent cataract phacoemulsification with intraocular lens implantation and pars plana vitrectomy for macular hole. All eyes were injected with expanding gas.
Results: Qualitative and quantitative results were followed in 20 patients, of which 14 men and 6 women with a mean age of 63.5 years. Anatomical closure of the macular hole on OCT examination was found in 100% of patients. Complications were not registered during the postoperative period. All patients were followed up at the first and second week, first, second, third, and sixth month after surgery. Visual acuity increased by up to 42% at the time of follow-up.
Conclusion: The combined surgical approach for the treatment of macular hole and lens opacity, leads to an earlier visual outcome and less psychoemotional stress for the patient.
Mann DF. Idiopathic macular hole. Optom Clin. 1996;5(1):95-110.
Majumdar S, Tripathy K. Macular Hole. [Updated 2023 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan
Sebag J. Age-related changes in human vitreous structure. Graefes Arch Clin Exp Ophthalmol. 1987;225(2):89-93. doi: 10.1007/BF02160337.
Huang LL, Levinson DH, Levine JP, et al. Optical coherence tomography findings in idiopathic macular holes. J Ophthalmol. 2011;2011:928205. doi: 10.1155/2011/928205.
Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991 May;109(5):654-9. doi: 10.1001/archopht.1991.01080050068031.
Ho AC, Guyer DR, Fine SL. Macular hole. Surv Ophthalmol. 1998 Mar-Apr;42(5):393-416. doi: 10.1016/s0039-6257(97)00132-x.
Khan A, Pope JM, Verkicharla PK, et al. Change in human lens dimensions, lens refractive index distribution and ciliary body ring diameter with accommodation. Biomed Opt Express. 2018;9(3):1272-1282. Published 2018 Feb 21. doi:10.1364/BOE.9.001272
Markatia Z, Hudson J, Leung EH, et al. The Postvitrectomy Cataract. Int Ophthalmol Clin. 2022 Jul 1;62(3):79-91. doi: 10.1097/IIO.0000000000000440.
Holekamp NM. The vitreous gel: more than meets the eye. Am J Ophthalmol. 2010 Jan;149(1):32-6. doi: 10.1016/j.ajo.2009.07.036. Epub 2009 Oct 28.
Davis G. The Evolution of Cataract Surgery. Mo Med. 2016 Jan-Feb;113(1):58-62.
Duker JS, Kaiser PK, Binder S, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013;120(12):2611-2619. doi:10.1016/j.ophtha.2013.07.042.
Gupta PK, Berdahl JP, Chan CC, et al. The corneal endothelium: clinical review of endothelial cell health and function. J Cataract Refract Surg. 2021;47(9):1218-26. doi:10.1097/j.jcrs.0000000000000650.
Vaiciuliene R, Rylskyte N, Baguzyte G, et al. Risk factors for fluctuations in corneal endothelial cell density (Review). Exp Ther Med. 2022 Feb;23(2):129. doi: 10.3892/etm.2021.11052.
Elhalis H, Azizi B, Jurkunas UV. Fuchs endothelial corneal dystrophy. Ocul Surf. 2010;8(4):173-184. doi:10.1016/s1542-0124(12)70232-x.
Solomon R, Tamilarasi S, Sachdev G, et al. Accuracy of Barrett versus third-generation intraocular lens formula across all axial lengths. Oman J Ophthalmol. 2022 Nov 2;15(3):290-294. doi: 10.4103/ojo.ojo_188_21.
Stopyra W, Langenbucher A, Grzybowski A. Intraocular Lens Power Calculation Formulas-A Systematic Review. Ophthalmol Ther. 2023;12(6):2881-902. doi:10.1007/s40123-023-00799-6.
Xia T, Martinez CE, Tsai LM. Update on Intraocular Lens Formulas and Calculations. Asia Pac J Ophthalmol (Phila). 2020 May-Jun;9(3):186-93. doi: 10.1097/APO.0000000000000293.
Silvanus MT, Moldzio P, Bornfeld N, et al. Visual loss following intraocular gas injection. Dtsch Arztebl Int. 2008 Feb;105(6):108-12. doi: 10.3238/arztebl.2008.0108.
Guillaubey A, Malvitte L, Lafontaine PO, et al. Comparison of face-down and seated position after idiopathic macular hole surgery: a randomized clinical trial. Am J Ophthalmol. 2008;146(1):128-34. doi:10.1016/j.ajo.2008.02.029
Theocharis IP, Alexandridou A, Gili NJ, Tomic Z. Combined phacoemulsification and pars plana vitrectomy for macular hole treatment. Acta Ophthalmol Scand. 2005;83(2):172-5. doi:10.1111/j.1600-0420.2005.00417.x.
Port AD, Nolan JG, Siegel NH, et al. Combined phaco-vitrectomy provides lower costs and greater area under the curve vision gains than sequential vitrectomy and phacoemulsification. Graefes Arch Clin Exp Ophthalmol. 2021;259(1):45-52. doi:10.1007/s00417-020-04877-4.
Daud F, Daud K, Popovic MM, et al. Combined versus Sequential Pars Plana Vitrectomy and Phacoemulsification for Macular Hole and Epiretinal Membrane: A Systematic Review and Meta-Analysis. Ophthalmol Retina. 2023;7(8):721-31. doi:10.1016/j.oret.2023.03.017.
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