The presence of an operculum verified by optical coherence tomography and other prognostic factors in macular hole surgery

Purpose: To evaluate the prognostic influence of the presence of an operculum in macular hole and to correlate the prognosis for postoperative visual acuity (VA) with the size of the macular hole, its duration and preoperative VA. Methods: We carried out a prospective study of 61 eyes of 59 patients with full thickness macular hole. All patients were examined with optical coherence tomography (OCT) in order to ascertain the presence of an operculum. The VA was measured with the ETDRS chart. A standard pars plana vitrectomy with inner limiting membrane peeling was performed in all cases and 20% C2F6 was used as tamponade. Results: Anatomical closure was obtained after one surgical procedure in 59/61 (97%) patients. Linear regression analysis showed only baseline VA to be predictive of visual outcome (p < 0.001). The presence of an operculum preoperatively did not correlate with VA either pre- or postoperatively, nor with the anatomical closure rate. Conclusion: The finding that postoperative VA in macular hole correlates with preoperative VA seems to allow for good prediction of postoperative VA in macular hole surgery. However, the presence of an operculum is of no prognostic significance.