[Long-term monitoring of visual function after anatomically successful surgical treatment of idiopathic macular holes].

PURPOSE: The purpose of the study is to determine the outcomes of long-term changes and evolution of visual acuity in patients undergoing anatomically successful macular hole surgery. MATERIALS AND METHODS: Into prospective study are enrolled 20 eyes (20 patients). All patients were successfully operated for idiopathic macular hole between September, 1996 and August, 1998. Time of follow up ranged from 20 to 43 months (mean, 29.5). The best corrected visual acuity was examined before operation and every 3 months after surgery. 12 eyes were operated for complicated cataract. The subgroup of 16 eyes was selected from the group of 20 eyes. The subgroup consisted of patients, who in the first examination observed in Watzke-Allen test the interruption of ray of light and there was a central scotoma on the campimetry. These tests were realised before operation and in the 3rd, 9th and 15th months after operation. Fisher's test and Student's t test were used for statistical analysis. RESULTS: Mean corrected visual acuity before operation was 0.21. Best corrected visual acuity was 0.44, reached in the 12th months. Improvement in +2 or more lines was reached in 55%. In 15th and 18th months the mean corrected visual acuity decrease because of the progression of nuclear sclerosis. 12 eyes were operated for complicated cataract. The best corrected visual acuity before and after surgery of idiopathic macular hole was 0.18 respectively 0.39 and improvement in +2 or more lines was reached in 6 (50%) eyes. After surgery of complicated cataract the mean visual acuity was 0.49. Further improvement in +2 or more lines was reached in 2 (16.7%) eyes, together in 8 (66,%) eyes. Statistical analysis (Fischer's tests, Student's t test) was significant (P < 0.05). In the subgroup of 16 eyes, where were followed changes in Watzke-Allen test, the interruption of ray of light was in all 16 (100%) patients. In the 3rd month 6 (37.5%) patients observed interruption of ray of light and other 10 (62.5%) observed deformation in the central part of ray of light. In 9th and 15th months the interruption observed 5 (31.25%) patients. Deformation in 9th and 15th months observed 8 (50%) respectively 5 (31.25%) patients. Gradual decrease of central scotoma observed in the 3rd, 9th and 15th month 10 (62.5%), 13 (81.25%) and 14 (87.5%) patients. During the follow up in 12 (75%) patients was reached total disappearance of central scotoma. CONCLUSIONS: The evolution of visual acuity after anatomically successful surgery of idiopathic macular hole is dynamic, long-standing and continual process. Improvement of visual acuity can be masked by progression of complicated cataract-nuclear sclerosis. Further improvement of visual acuity can be observed after of the surgery complicated cataract.