Discussion by thomas R. Friberg, MD

Objective

To evaluate the visual and anatomic results of surgically repaired macular holes in eyes with intermediate or large-sized macular drusen.

Design

Retrospective noncomparative case series.

Participants

Thirty-four eyes of 32 patients undergoing macular hole surgery with preoperative intermediate or large-sized macular drusen as defined by the Age-Related Eye Disease Study (AREDS).

Intervention

Pars plana vitrectomy for standard macular hole repair performed by multiple surgeons.

Main outcome measures

Visual acuity, anatomic hole closure.

Results

Initial hole closure failed in 8 eyes (24%) overall, 5 of 28 eyes (18%) with AREDS category 2 drusen and 3 of 6 eyes (50%) with category 3 drusen (P = 0.1263). Final macular hole closure was seen in 93% of category 2 and 67% of category 3 eyes (P = 0.1347). Mean final visual acuity was 20/60 overall, 20/60 for category 2, and 20/50 for category 3 eyes.

Conclusions

A trend of reduced initial macular hole closure was seen in eyes with significant macular drusen. Reoperation improved closure rates. If closure was accomplished, visual outcomes were excellent.