[Pars plana vitrectomy for idiopathic macular hole--visual improvement or merely surgical stress?].

BACKGROUND: The aim of this study was to compare the functional results of surgical treatment of idiopathic macular holes in controlled clinical studies with those of the "real world" in the clinical routine. METHODS: The operated eyes of patients of a rural district (Saalfeld-Rudolstadt, Germany) during 2000-2009 were analysed based on the documentation of the postoperative care of all ophthalmologists in this region. RESULTS: 37 eyes of 37 patients (age 71 years, 45; 80) (median, [min; max]) operated in 7 clinical institutes were analysed. The past medical history until surgery was 4 months (1; 72) and the preoperative visual acuity (VA) 0.2 (0.01; 0.5). The observational period after surgery was 2.3 years (1; 6 years), all eyes were documented over more then 1 year thereafter. At the last control the VA improved ≥ 2 lines in 17 eyes (46%) and decreased ≥ 2 lines in 8 (22%). 13 eyes (35%) obtained a VA ≥ 0.5. A short preoperative period corresponded with a visual improvement (K = 0.40, p = 0.01). A further increase of VA after one year could be observed only due to cataract surgery or Nd:YAG laser capsulotomy. 8 eyes (22%) needed at least one more vitreoretinal surgery. DISCUSSION: Reasons for the disappointing functional results compared with the literature could be long medical history, not differentiated grades of macular holes and developing surgical techniques during the analysis period. Retrospective analyses of the outcome of routine practical work seems to be a necessary complement of controlled clinical studies despite their methodical deficits. New prognostic criteria are needed for a better indication for surgery and an improved counselling of the patient.