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Brockmann, Tobias MD*; Steger, Claudia MD*; Weger, Martin MD; Wedrich, Andreas MD; Haas, Anton MD

doi: 10.1097/IAE.0b013e31827c5384
Original Studies

Background: The purpose of this study was to investigate and identify predictors for idiopathic macular hole persistence after pars plana vitrectomy with dye-assisted internal limiting membrane peeling.

Methods: In a retrospective case series, 160 eyes underwent identical vitreoretinal procedures performed by the same surgeon. Baseline characteristics and preoperative optical coherence tomography were evaluated regarding the postoperative anatomical outcome.

Results: n overall closure rate of 86.3% (138/160) was achieved. According to the Gass classification system, the closure rates were 100.0% (11/11) in Stage 2, 95.0% (57/60) in Stage 3, and 78.7% (70/89) in Stage 4. Thereby, a significant influence of preoperative best-corrected visual acuity and basal hole diameter was observed. Especially, idiopathic macular hole with a basal hole diameter of ≥800 μm and a best-corrected visual acuity of ≤20/100 had a 4 and 6 times higher risk to persist, respectively. On the other hand, age, gender, bilateral occurrence, symptom duration, and lens status did not have an effect on the surgical outcome. Furthermore, perifoveal pseudocysts were associated with a higher closure rate in Stage 4 idiopathic macular hole.

Conclusion: Simple clinical parameters such as best-corrected visual acuity, basal diameter, and perifoveal pseudocysts are efficient predictors and might be used to expand the validity of the Gass classification.

The anatomical outcome of 160 consecutive idiopathic macular holes after pars plana vitrectomy was analyzed to investigate predictive parameters. Thereby, preoperative best-corrected visual acuity, basal diameter, and perifoveal pseudocysts were found to be decisive predictors and might be considered for further risk stratification beyond Gass classification.

*Department of Ophthalmology, Charité, University Medicine Berlin, Berlin, Germany

Department of Ophthalmology, Medical University Graz, Graz, Austria.

Reprint requests: Anton Haas, MD, Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036 Graz, Austria; e-mail:

None of the authors have any financial/conflicting interests to disclose.

T. Brockmann and C. Steger contributed equally to this work.

© 2013 by Ophthalmic Communications Society, Inc.