Optimizing patient-important outcomes in full-thickness macular hole repair

Abstract

Background: Full-thickness macular holes (FTMHs) are complete defects in the fovea affecting all retinal layers. They greatly impact patients’ visual acuity (VA) and reduce their quality of life. Repair involves pars plana vitrectomy (PPV) with peeling of the internal limiting membrane (ILM), intraocular gas tamponade, and post-operative face-down positioning (FDP). This sandwich thesis presents four published articles with the focus on optimizing patient-important outcomes in the management of idiopathic FTMHs. Chapter 1 provides the relevant background information, rationale, and framework for the thesis. Chapter 2 presents the results of a systematic review and individual participant data meta-analysis of randomized controlled trials (RCTs) evaluating the impact of modifying intraoperative ILM peel size. Specifically, the review compares “small”, defined as 1 disc diameter (DD) in radius or less, compared to “large”, defined as greater than 1 DD in radius. Chapter 3 presents the results of a systematic review and meta-analysis of RCTs evaluating the impact of post-operative FDP versus no FDP. Chapter 4 presents a published editorial outlining the types, the utility, and common pitfalls to feasibility studies. Chapter 5 describes a detailed protocol for a pilot RCT. This study will assess the feasibility of a larger scale trial comparing three versus seven days of post-operative FDP following PPV for FTMH. Chapter 6 summarizes the results of the studies and presents future directions to facilitate further improvements in the management of FTMHs.