Visual and Anatomic Outcome in Eyes with Idiopathic Juxtafoveal Macular Telangiectasia (MacTel) and Full Thickness Macular Holes Undergoing Surgical Repair

摘要

Purpose: To report visual and anatomic outcomes in eyes with idiopathic juxtafoveal macular telangiectasia (MacTel) undergoing small gauge vitrectomy surgery with gas tamponade for full thickness macular holes (FTMH) Methods: Medical records of all adult patients with the diagnoses of both MacTel and FTMH who were diagnosed and had surgery between 2003-2013 at Casey Eye Institute were reviewed. Preoperative and postoperative data were obtained including visual acuity and OCT imaging to evaluate the overall visual acuity changes and the macular hole closure rates. These cases were then compared with historical controls that also underwent surgical repair as well as those undergoing observation only. Results: Over a 10- year period, 2 cases that met the search criteria were identified (Patient A and B). Hole closure was obtained in 1 of 2 cases, with both cases requiring multiple procedures. Patient A is a 58 year-old woman with a VA OS of 20/400 and an OCT illustrating a macular hole greater than 500 microns, who underwent 3 surgical repairs including ILM peel without hole closure. Patient B is a 62 year-old gentlemen who presented with VA OD 20/200 and a macular hole of 320 microns, and underwent 5 surgical interventions with eventual hole closure. Overall, final visual acuity was unchanged in these cases. Six prior cases undergoing surgical repair have been reported in the literature. In 3 of these cases, the holes closed while in 3 cases the hole remained open. In addition, 3 cases had improved vision while 2 had no vision changes and the 3rd had reduced vision post-operatively. In those cases undergoing observation only, visual acuity tends to remain stable over time. Conclusions: Surgical intervention for MacTel and FTMH may not provide visual acuity benefit. Eyes with mactel tend to have stable visual acuity even with the development of a FTMH as the mechanism of hole formation is probably degenerative in nature rather than tractional with lateral separation of the photoreceptors and loss of Mueller cell structural support. Unless visual acuity decreases dramatically or definite vitreo-macular traction is noted, surgical intervention may not be beneficial.