Surgery for Idiopathic Full-Thickness Macular Hole: Two-Year Results of a Randomized Clinical Trial Comparing NaturalHistory, Vitrectomy, and Vitrectomy Plus Autologous Serum: Moorfields MacularHole Study Group Report No. 1 | Ophthalmology | JAMA Ophthalmology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.153.100.128. Please contact the publisher to request reinstatement.
1.
Kelly  NEWendel  RT Vitreous surgery for idiopathic macular holes: results of a pilot study.  Arch Ophthalmol. 1991;109654- 659PubMedGoogle ScholarCrossref
2.
Wendel  RTPatel  ACKelly  NESalzano  TCWells  JWNovack  GD Vitreous surgery for macular holes.  Ophthalmology. 1993;1001671- 1676PubMedGoogle ScholarCrossref
3.
Glaser  BMMichels  RGKupperman  BD  et al.  The effects of pars plana vitrectomy and transforming growth factor-beta2 for the treatment of full-thickness macular holes: a prospective randomizedstudy.  Ophthalmology. 1992;991162- 1173PubMedGoogle ScholarCrossref
4.
Lansing  MBGlaser  BMLiss  H  et al.  The effect of pars plana vitrectomy and transforming growth factor-beta2 without epiretinal membrane peeling on full-thickness macular holes.  Ophthalmology. 1993;100868- 871PubMedGoogle ScholarCrossref
5.
Orrellana  JLieberman  RM Stage III macular hole surgery.  Br J Ophthalmol. 1993;77555- 558PubMedGoogle ScholarCrossref
6.
Smiddy  WEGlaser  BMThompson  JT  et al.  Transforming growth factor-beta 2 significantly enhances the abilityto flatten the rim of subretinal fluid surrounding macular holes: preliminaryanatomic results of a multicentre prospective randomized study.  Retina. 1993;13296- 301PubMedGoogle ScholarCrossref
7.
Ryan  EHGilbert  HD Results of surgical treatment of recent-onset full-thickness idiopathicmacular holes.  Arch Ophthalmol. 1994;1121545- 1553PubMedGoogle ScholarCrossref
8.
Ruby  AJWilliams  DFGrand  MG  et al.  Pars plana vitrectomy for treatment of stage 2 macular holes.  Arch Ophthalmol. 1994;112359- 364PubMedGoogle ScholarCrossref
9.
Wells  JAGregor  ZJ Surgical treatment of full-thickness macular holes using autologousserum.  Eye. 1996;10593- 599PubMedGoogle ScholarCrossref
10.
Kim  JWFreeman  WRAzen  SP  et al.  Prospective randomized trial of vitrectomy for stage 2 macular holes.  Am J Ophthalmol. 1996;121605- 614PubMedGoogle Scholar
11.
Freeman  WRAzen  SPKim  JW  et al.  Vitrectomy for the treatment of full-thickness stage 3 or 4 macularholes: results of a multicenter randomized controlled trial.  Arch Ophthalmol. 1997;11511- 22PubMedGoogle ScholarCrossref
12.
Ezra  EAylward  WGGregor  ZJ Membranectomy and autologous serum for the retreatment of full-thicknessmacular holes.  Arch Ophthalmol. 1997;1151276- 1280PubMedGoogle ScholarCrossref
13.
Kim  JWFreeman  WREl-Haig  WMaguire  AMArevalo  JFAzen  SP Baseline characteristics, natural history, and risk factors to progressionin eyes with stage 2 macular holes: results from a prospective randomizedclinical trial.  Ophthalmology. 1995;1021818- 1829PubMedGoogle ScholarCrossref
14.
Thompson  JTSmiddy  WEWilliams  GA  et al.  Comparison of recombinant transforming growth factor beta-2 and placeboas an adjunctive agent for macular hole surgery.  Ophthalmology. 1998;105700- 706PubMedGoogle ScholarCrossref
15.
Thompson  JTSjaarda  RNGlaser  BMMurphy  RP Increased intraocular pressure after macular hole surgery.  Am J Ophthalmol. 1996;121615- 622PubMedGoogle Scholar
16.
Liggett  PESkolik  SHorio  B  et al.  Human autologous serum for the treatment of full thickness macularholes: a preliminary study.  Ophthalmology. 1995;1021071- 1076PubMedGoogle ScholarCrossref
17.
Christmas  NJSkolik  SAHoward  MASaito  YBarnstable  CJLiggett  PE Treatment of retinal breaks with autologous serum in an experimentalmodel.  Ophthalmology. 1995;102263- 271PubMedGoogle ScholarCrossref
18.
Gaudric  AMassin  PPaques  M  et al.  Autologous platelet concentrate for the treatment of full thicknessmacular holes.  Graefes Arch Clin Exp Ophthalmol. 1995;233549- 554PubMedGoogle ScholarCrossref
19.
Paques  MChastang  CMathis  A  et al.  Effect of autologous platelet concentrate in surgery for idiopathicmacular hole: results of a multicentre, double-masked, randomised trial.  Ophthalmology. 1999;106932- 938PubMedGoogle ScholarCrossref
20.
Korobelnik  JFHannouche  DBelayachi  N  et al.  Autologous platelet concentrate as an adjunct in macular hole surgery:a pilot study.  Ophthalmology. 1996;103590- 594PubMedGoogle ScholarCrossref
21.
Blumenkranz  MSO'Hana  EShaik  S  et al.  Adjuvant methods in macular hole surgery: intraoperative plasma-thrombinmixture and postoperative fluid-gas exchange.  Ophthalmic Surg Lasers. 2001;32198- 207PubMedGoogle Scholar
22.
Iwasaki  TSanda  AYamamoto  KOkade  AUsui  NM The use of fibrin tissue adhesive in the treatment of macular holes.  Invest Ophthalmol Vis Sci. 1995;361050- 1056Google Scholar
23.
Tilanus  MADeutman  AF Full-thickness macular holes treated with vitrectomy and tissue glue.  Int Ophthalmol. 1994;9518355- 358PubMedGoogle Scholar
24.
Olsen  TWSternberg  PMartin  DF  et al.  Postoperative hypopyon after intravitreal bovine thrombin for macularhole surgery.  Am J Ophthalmol. 1996;121575- 577PubMedGoogle Scholar
25.
Thompson  JTGlaser  BMSjaarda  RN  et al.  Effects of intraocular bubble duration in the treatment of macularholes by vitrectomy and transforming growth factor beta-2.  Ophthalmology. 1994;1011195- 1200PubMedGoogle ScholarCrossref
26.
Ryan  EALee  SChern  S Use of intravitreal autologous blood to identify the posterior corticalvitreous in macular hole sugery.  Arch Ophthalmol. 1995;113822- 823PubMedGoogle Scholar
27.
Lewis  JMPark  IOhji  M  et al.  Diamond-dusted silicone cannula for epiretinal membrane separationduring vitreous surgery.  Am J Ophthalmol. 1997;124552- 554PubMedGoogle Scholar
28.
Margherio  RRMargherio  ARWilliams  GAChow  DRBanach  MJ Effect of perifoveal tissue dissection in the management of acute idiopathicfull-thickness macular hole.  Arch Ophthalmol. 2000;118495- 498PubMedGoogle ScholarCrossref
29.
Cheng  LFreeman  WROzerdem  USong  MKAzen  SP Prevalence, correlates and natural history of epiretinal membrane surroundingidiopathic macular holes: Vitrectomy for Macular Hole Study Group.  Ophthalmology. 2000;107853- 859PubMedGoogle ScholarCrossref
30.
Olsen  TWSternberg  PCapone  A  et al.  Macular hole surgery using thrombin-activated fibrinogen and selectiveremoval of the internal limiting membrane.  Retina. 1998;18322- 329PubMedGoogle ScholarCrossref
31.
Park  DWSipperly  JOSneed  SRDugel  PUJacobsen  J Macular hole surgery with internal limiting membrane peeling and intravitreousair.  Ophthalmology. 1999;1061392- 1397PubMedGoogle ScholarCrossref
32.
Freeman  WRAzen  SP Evaluation of new techniques in macular surgery.  Ophthalmology. 1999;106861- 862PubMedGoogle ScholarCrossref
33.
Mester  VKuhn  F Internal limiting membrane removal in the management of full-thicknessmacular hole.  Am J Ophthalmol. 2000;129769- 777PubMedGoogle ScholarCrossref
34.
Kadonosono  KItoh  NUchio  ENakamura  SOhno  S Staining of the internal limiting membrane in macular hole surgery.  Arch Ophthalmol. 2000;1181116- 1118PubMedGoogle ScholarCrossref
35.
Brooks  HL Macular hole surgery with and without internal limiting membrane peeling.  Ophthalmology. 2000;1071939- 1948PubMedGoogle ScholarCrossref
36.
Goldbaum  MHMcCuen  BWHanneken  AMBurgess  SKChen  HH Silicone oil tamponade to seal macular holes without position restrictions.  Ophthalmology. 1998;1052140- 2147PubMedGoogle ScholarCrossref
37.
Pertile  GClaes  C Silicone oil versus gas for the treatment of full-thickness macularhole.  Bull Soc Belge Ophtalmol. 1999;27431- 36PubMedGoogle Scholar
38.
Jumper  JMGallemore  RPMcCuen  BWToth  CA Features of macular hole closure in the early postoperative periodusing optical coherence tomography.  Retina. 2000;20232- 237PubMedGoogle ScholarCrossref
39.
Aaberg  TMBlair  CJGass  JDM Macular holes.  Am J Ophthalmol. 1970;69555- 562PubMedGoogle Scholar
40.
Aaberg  TM Macular holes: a review.  Surv Ophthalmol. 1970;15139- 162Google Scholar
41.
Gass  JDM Stereoscopic Atlas of Macular Diseases: Diagnosisand Treatment. 11st St Louis, Mo Mosby–Year Book Inc195- 199
42.
Margherio  RRSchepens  CL Macular breaks, I: diagnosis, etiology, and observations.  Am J Ophthalmol. 1972;74219- 232PubMedGoogle Scholar
43.
Gass  JDM Idiopathic senile macular hole: its early stages and development.  Arch Ophthalmol. 1988;106629- 639PubMedGoogle ScholarCrossref
44.
Johnson  RNGass  JDM Idiopathic macular holes: observations, stages of formation and implicationsfor surgical intervention.  Ophthalmology. 1988;95917- 924PubMedGoogle ScholarCrossref
45.
Guyer  DRde Bustros  SDiener-West  MFine  SL The natural history of idiopathic macular holes and cysts.  Arch Ophthalmol. 1992;1101264- 1268PubMedGoogle ScholarCrossref
46.
Hikichi  TYoshida  AAkiba  JKonno  STrempe  CL Prognosis of stage 2 macular holes.  Am J Ophthalmol. 1995;119571- 575PubMedGoogle Scholar
47.
Kakehashi  ASchepens  CLAkiba  JHikichi  TTrempe  CL Spontaneous resolution of foveal detachments and macular breaks.  Am J Ophthalmol. 1995;120767- 775PubMedGoogle Scholar
48.
Thompson  JTGlaser  BMSjaarda  RNMurphy  RP Progression of nuclear sclerosis and long-term visual results aftervitrectomy with transforming growth factor beta-2 for macular holes.  Am J Ophthalmol. 1995;11948- 54PubMedGoogle Scholar
49.
Ezra  EArden  GBRiordan-Eva  PAylward  WGGregor  ZJ Peripheral field loss following pars plana vitrectomy for stage 2 and3 macular holes.  Br J Ophthalmol. 1996;80519- 525PubMedGoogle ScholarCrossref
50.
Boldt  HCMunden  PMFolk  JCMehaffey  MG Visual field defects after macular hole surgery.  Am J Ophthalmol. 1996;122371- 381PubMedGoogle Scholar
51.
Kerrison  JBHaller  JAElman  MMiller  NR Visual field loss following vitreous surgery.  Arch Ophthalmol. 1996;114564- 569PubMedGoogle ScholarCrossref
52.
Pendergast  SDMcCuen  BW Visual field loss after macular hole surgery.  Ophthalmology. 1996;1031069- 1077PubMedGoogle ScholarCrossref
53.
Bopp  SLucke  KHille  U Peripheral visual field loss after vitreous surgery for macular hole.  Graefes Arch Clin Exp Ophthalmol. 1997;235362- 371PubMedGoogle ScholarCrossref
54.
Paques  MMassin  PSantiago  PY  et al.  Visual field loss after vitrectomy for full-thickness macular holes.  Am J Ophthalmol. 1997;12488- 94PubMedGoogle Scholar
55.
Ohji  MNao-I  NSaito  YHayashi  ATano  Y Prevention of visual field defect after macular hole surgery by passingair used for fluid-air exchange through water.  Am J Ophthalmol. 1999;12762- 66PubMedGoogle ScholarCrossref
56.
Groenewald  CPWong  DPearce  IHiscott  PGrierson  I Nasal epipapillary membrane causing visual field loss following macularhole surgery.  Eye. 1998;12328- 330PubMedGoogle ScholarCrossref
57.
Cullinane  ABCleary  PE Prevention of visual field defects after macular hole surgery.  Br J Ophthalmol. 2000;84372- 377PubMedGoogle ScholarCrossref
58.
Oh  KTBoldt  HCMaturi  RKFolk,  JCKardon  RH Evaluation of patients with visual field defects following macularhole surgery using multifocal electroretinography.  Retina. 2000;20238- 243PubMedGoogle ScholarCrossref
59.
Park  SSMarcus  DMDuker  JS  et al.  Posterior segment complications after vitrectomy for macular hole.  Ophthalmology. 1995;102775- 781PubMedGoogle ScholarCrossref
60.
Banker  ASFreeman  WRKim  JW  et al.  Vision threatening complications of surgery for full-thickness macularholes: Vitrectomy for Macular Hole Study Group.  Ophthalmology. 1997;1041442- 1452PubMedGoogle ScholarCrossref
61.
Tabandeh  HChaudhry  NASmiddy  WE Retinal detachments associated with macular hole surgery: characteristics,mechanisms and outcomes.  Retina. 1999;19281- 286PubMedGoogle ScholarCrossref
62.
Charles  S Retinal pigment epithelial abnormalities after macular hole surgery[letter].  Retina. 1993;13176PubMedGoogle ScholarCrossref
63.
Poliner  LSTornambe  PE Retinal pigment epitheliopathy after macular hole surgery.  Ophthalmology. 1992;991671- 1677PubMedGoogle ScholarCrossref
64.
Chen  C Glaucoma after macular hole surgery.  Ophthalmology. 1998;10594- 99PubMedGoogle ScholarCrossref
65.
Banker  ASFreeman  WRAzen  SPLai  MY A multicentred clinical study of serum as adjunctive therapy for surgicaltreatment of macular holes: Vitrectomy for Macular Hole Study Group.  Arch Ophthalmol. 1999;1171499- 1502PubMedGoogle ScholarCrossref
66.
Fine  SL Macular hole: a continuing saga.  Arch Ophthalmol. 1999;117248- 249PubMedGoogle ScholarCrossref
67.
Standards of Reporting Trials Group, A proposal for structured reporting of randomised controlled trials  JAMA. 1994;2721926- 1931[published correction appears in JAMA.1995;273:776].PubMedGoogle ScholarCrossref
68.
Begg  CCho  MEastwood  S  et al.  Improving the quality of reporting of randomized controlled trials:the CONSORT statement.  JAMA. 1996;276637- 639PubMedGoogle ScholarCrossref
69.
Rennie  D How to report randomised controlled trials: the CONSORT statement [editorial].  JAMA. 1996;276649PubMedGoogle ScholarCrossref
70.
Ferris  FL  IIISperduto  R Standardized illumination for visual acuity testing in clinical research.  Am J Ophthalmol. 1982;9497- 99PubMedGoogle Scholar
71.
Ferris  FLKassoff  ABailey  I New visual acuity charts for clinical research.  Am J Ophthalmol. 1982;9491- 96PubMedGoogle Scholar
72.
Early Treatment Diabetic Retinopathy Study Research Group, Photocoagulation for diabetic macular edema: Early Treatment DiabeticRetinopathy Study report number 1.  Arch Ophthalmol. 1985;1031796- 1806PubMedGoogle ScholarCrossref
73.
Duker  JSWendel  RTPatel  ACPuliafito  CA Late reopening of macular holes following initially successful vitreoussurgery.  Ophthalmology. 1994;1011373- 1378PubMedGoogle ScholarCrossref
74.
Del Priore  LVKaplan  HJBonham  FD Laser photocoagulation and fluid-gas exchange for recurrent macularhole.  Retina. 1994;14381- 382PubMedGoogle ScholarCrossref
75.
Paques  MMassin  PSantiago  PY  et al.  Late reopening of successfully treated macular holes.  Br J Ophthalmol. 1997;81658- 662PubMedGoogle ScholarCrossref
76.
Christmas  NJSmiddy  WEFlynn  HW Reopening of macular holes after initially successful repair.  Ophthalmology. 1998;1051835- 1838PubMedGoogle ScholarCrossref
77.
Paques  MMassin  PBlain  PDuquesnoy  ASGaudric  A Long-term incidence of reopening of macular holes.  Ophthalmology. 2000;107760- 765PubMedGoogle ScholarCrossref
78.
James  MFeman  SS Macular holes.  Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1980;21559- 63Google ScholarCrossref
79.
McDonnell  PJFine  SLHillis  AI Clinical features of idiopathic macular cysts and holes.  Am J Ophthalmol. 1982;93777- 786PubMedGoogle Scholar
80.
Morgan  CMSchatz  H Idiopathic macular holes.  Am J Ophthalmol. 1985;99437- 444PubMedGoogle Scholar
81.
Scott  RAEzra  EWest  JFGregor  ZJ Visual and anatomical results of surgery for long standing macularholes.  Br J Ophthalmol. 2000;84150- 153PubMedGoogle ScholarCrossref
Clinical Sciences
February 2004

Surgery for Idiopathic Full-Thickness Macular Hole: Two-Year Results of a Randomized Clinical Trial Comparing NaturalHistory, Vitrectomy, and Vitrectomy Plus Autologous Serum: Moorfields MacularHole Study Group Report No. 1

Eric Ezra, MD, FRCS, FRCOphth; Zdenek J. Gregor, FRCS, FRCOphth; Moorfields Macular Hole Study Group
Author Affiliations

From the Vitreoretinal Service, Moorfields Eye Hospital, London, England.A complete list of the members of the Moorfields Macular Hole Study Groupappears below. The authors have no relevant financial interest in this article.

Arch Ophthalmol. 2004;122(2):224-236. doi:10.1001/archopht.122.2.224
Abstract

Objectives  To determine the benefits of idiopathic full-thickness macular hole(FTMH) surgery compared with observation and to evaluate the use of autologousserum as an intraoperative adjunct.

Methods  A randomized clinical trial was performed to evaluate the anatomic andvisual benefits of FTMH surgery for lesions of 9 months or less symptom durationand visual acuity of 20/60 or less. We compared surgery with natural historyand determined whether use of intraoperative adjunctive autologous serum improvesthe surgical outcome. Eyes were randomized to (1) observation, (2) vitrectomy,or (3) vitrectomy plus serum and were followed for 24 months to assess anatomicstatus and visual function.

Results  In total, 185 eyes of 174 patients were enrolled. In the observationgroup, spontaneous closure of the FTMH occurred in 7 (11.5%) of 61 patients,with little or no change in overall acuity levels in 24 months. In contrast,the surgical groups had an overall closure rate of 80.6% (100/124) at 24 months,with 45% of eyes achieving Snellen acuity of 20/40 or greater. Surgical eyeshad better median near acuity than observation eyes by 6 lines (N5 vs N14).Use of autologous serum did not seem to affect anatomic or visual results.At 24 months, 72 (58.1%) of 124 surgical eyes had undergone cataract extraction.

Conclusions  Surgery for FTMH is safe and effective and is associated with significantvisual improvement compared with the natural history. Autologous serum applicationdoes not enhance the results of surgery.

×