The macular hole: report of an Australian surgical series and meta‐analysis of the literature

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Abstract
Purpose: To report an Australian series of macular hole surgery by pars plana vitrectomy and fluid‐gas exchange, and to identify factors influencing the outcome of the surgery through meta‐analysis of the literature. Methods: Fifty‐six consecutive cases of macular hole were treated by pars plana vitrectomy, fluid‐gas exchange and face‐down positioning for at least 7 days, and prospectively followed for 3–12 months. Thirty‐six reports of macular hole surgery were reviewed. A meta‐analysis on the pre‐ and postoperative parameters was performed on 389 cases, in which case‐specific data‐points were available. Results: In the current series, anatomical closure was achieved in all (100%) of 16 stage 2, and in 35 (87.5%) of 40 stage 3 or 4 macular holes. At least 2 logMAR lines of improvement in visual acuity were seen in 10 (62.5%) stage 2 and 20 (50.0%) stage 3 or 4 holes. Postoperative visual acuity was 6/12 or better in 10 (62.5%) stage 2 and 17 (42.5%) stage 3 or 4 holes. In both the current series and the meta‐analysis, favourable surgical outcomes were associated with stage 2 macular holes, better preoperative visual acuity, and shorter preoperative duration. Adjuvant use was associated with a higher rate of anatomical closure but there was no clear benefit in terms of postoperative visual acuity. Conclusion: Our experience and the results of the meta‐analysis suggest that macular hole surgery should be offered as early as possible once full‐thickness neuroretinal defect occurs.