International Ophthalmology

, Volume 39, Issue 12, pp 2775–2783 | Cite as

Vision-related quality of life after pars plana vitrectomy with or without combined cataract surgery for idiopathic macular hole patients

  • Yi Wang
  • Xida Liang
  • Meng Gao
  • Ju Liu
  • Limei Liu
  • Wu LiuEmail author
Original Paper



To evaluate the influence of vision-related quality of life (VR-QOL) after pars plana vitrectomy (PPV) with or without combined cataract surgery for idiopathic macular hole (IMH) patients.


This prospective consecutive case series study included 53 eyes of 53 consecutive IMH patients who were divided into two groups: 34 eyes underwent PPV combined with cataract surgery (combined group), 19 eyes only underwent PPV (vitrectomy group). Clinical data were collected at baseline and 3 and 6 months after surgery, respectively, including VR-QOL evaluated by The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25), logarithm of minimal angle of resolution best-corrected visual acuity (logMAR BCVA) using ETDRS chart, severity of metamorphopsia evaluated by M-Charts, contrast sensitivity evaluated by functional acuity contrast test, MH diameter detected by SD-OCT and lens opacity assessment evaluated by Lens Opacity Classification System III (LOCS III). ANOVA and LSD, Wilcoxon signed-rank test were used to compare the difference in logMAR BCVA, metamorphopsia scores, contrast sensitivity, LOCS III scores and VFQ-25 scores between three time points; Spearman’s rank correlation test was used to test the correlations between logMAR BCVA, metamorphopsia scores, contrast sensitivity, LOCS III scores and VFQ-25 scores.


All eyes had achieved an anatomical success after surgery in both groups. BCVA (logMAR), metamorphopsia and contrast sensitivity were significantly improved at month 3 and month 6 (p = < 0.005). VFQ-25 composite and four subscale scores (general vision, near activities, distant activities, role difficulties) were significantly improved in combined group at month 6 compared with baseline (p = 0.011, 0.001, 0.003, < 0.001, 0.009). VFQ-25 composite and two subscale scores (general vision, role difficulties) were significantly and negatively correlated with logMAR BCVA (p = 0.046, 0.011, 0.012) and metamorphopsia (p = 0.009, 0.002, < 0.001) in combined group. VFQ-25 composite and four subscale scores (general vision, near activities, distance activities, mental health) were significantly improved in vitrectomy group at month 3 compared with baseline (p = 0.014, 0.047, 0.011, 0.018, 0.037). VFQ-25 composite score and mental health score were significantly decreased in vitrectomy group at month 6 compared with month 3 (p = 0.031, 0.029) and were significantly and negatively correlated with LOCS III score (p = 0.047, 0.017) at month 6.


Visual function and VR-QOL were significantly improved after successful macular hole surgery. The fluctuation of VR-QOL after surgery was attributed to the progression of the lens opacity. PPV combined with cataract surgery can help macular hole patients to maintain stable VR-QOL improvement by degrees.


Macular hole VR-QOL Vitrectomy Cataract 


Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    La CM, Friis J (2002) Macular holes: classification, epidemiology, natural history and treatment. Acta Ophthalmol Scand 80(6):579CrossRefGoogle Scholar
  2. 2.
    Kelly NE, Wendel RT (1991) Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol 109(5):654CrossRefGoogle Scholar
  3. 3.
    Sheidow TG, Blinder KJ, Holekamp N, Joseph D, Shah G, Grand MG, Thomas MA, Bakal J, Sharma S (2003) Outcome results in macular hole surgery: an evaluation of internal limiting membrane peeling with and without indocyanine green. Ophthalmology 110(9):1697–1701CrossRefGoogle Scholar
  4. 4.
    Park DW, Sipperley JO, Sneed SR, Dugel PU, Jacobsen J (1999) Macular hole surgery with internal-limiting membrane peeling and intravitreous air. Ophthalmology 106(7):1392CrossRefGoogle Scholar
  5. 5.
    Benson WE, Cruickshanks KC, Fong DS, Williams GA, Bloome MA, Frambach DA, Kreiger AE, Murphy RP (2001) Surgical management of macular holes: a report by the American Academy of Ophthalmology. Ophthalmology 108(7):1328–1335CrossRefGoogle Scholar
  6. 6.
    Haritoglou C, Gass CA, Schaumberger M, Gandorfer A, Ulbig MW, Kampik A (2002) Long-term follow-up after macular hole surgery with internal limiting membrane peeling. Am J Ophthalmol 134(5):661–666CrossRefGoogle Scholar
  7. 7.
    Muselier A, Dugas B, Burelle X, Passemard M, Hubert I, Mathieu B, Berrod JP, Bron AM, Creuzot-Garcher C (2010) Macular hole surgery and cataract extraction: combined vs consecutive surgery. Am J Ophthalmol 150(3):387–391CrossRefGoogle Scholar
  8. 8.
    Thompson JT, Glaser BM, Sjaarda RN, Murphy RP (1995) Progression of nuclear sclerosis and long-term visual results of vitrectomy with transforming growth factor beta-2 for macular holes. Am J Ophthalmol 119(1):48CrossRefGoogle Scholar
  9. 9.
    Chung TY, Chung H, Lee JH (2002) Combined surgery and sequential surgery comprising phacoemulsification, pars plana vitrectomy, and intraocular lens implantation: comparison of clinical outcomes. J Cataract Refract Surg 28(11):2001–2005CrossRefGoogle Scholar
  10. 10.
    Stein JD (2004) Disparities between ophthalmologists and their patients in estimating quality of life. Curr Opin Ophthalmol 15(3):238–243CrossRefGoogle Scholar
  11. 11.
    Maxwell A, Rajagopalan K (2005) Quality-of-life improvements in cataract patients with bilateral blue light-filtering intraocular lenses: clinical trial. J Cataract Refract Surg 31(10):1952–1959CrossRefGoogle Scholar
  12. 12.
    Mckeancowdin R, Wang Y, Wu J, Azen SP, Varma R (2008) Impact of visual field loss on health-related quality of life in glaucoma: the Los Angeles Latino Eye Study. Ophthalmology 115(6):941–948CrossRefGoogle Scholar
  13. 13.
    Lotery A, Xu X, Zlatava G, Loftus J (2007) Burden of illness, visual impairment and health resource utilisation of patients with neovascular age-related macular degeneration: results from the UK cohort of a five-country cross-sectional study. Br J Ophthalmol 91(10):1303–1307CrossRefGoogle Scholar
  14. 14.
    Klein R, Moss SE, Klein BE, Gutierrez P, Mangione CM (2001) The NEI-VFQ-25 in people with long-term type 1 diabetes mellitus: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Arch Ophthalmol 119(5):733–740CrossRefGoogle Scholar
  15. 15.
    Kymes SM, Walline JJ, Zadnik K, Gordon MO (2004) Quality of life in keratoconus. Am J Ophthalmol 138(4):527–535CrossRefGoogle Scholar
  16. 16.
    Okamoto F, Okamoto Y, Hiraoka T, Oshika T (2008) Vision-related quality of life and visual function after retinal detachment surgery. Am J Ophthalmol 146(1):85–90CrossRefGoogle Scholar
  17. 17.
    Ghazinouri SMS, Tranos PG, Rubin GS, Adams ZC, Charteris DG (2006) Visual function and quality of life following vitrectomy and epiretinal membrane peel surgery. Br J Ophthalmol 90(5):559CrossRefGoogle Scholar
  18. 18.
    Tranos PG, Ghazinouri SM, Rubin GS, Adams ZC, Charteris DG (2004) Visual function and subjective perception of visual ability after macular hole surgery. Am J Ophthalmol 138(6):995–1002CrossRefGoogle Scholar
  19. 19.
    Hirneiß C, Neubauer AS, Gass CA, Reiniger IW, Priglinger SG, Kampik A, Haritoglou C (2007) Visual quality of life after macular hole surgery: outcome and predictive factors. Br J Ophthalmol 91(4):481CrossRefGoogle Scholar
  20. 20.
    Fukuda S, Okamoto F, Yuasa M, Kunikata T, Okamoto Y, Hiraoka T, Oshika T (2009) Vision-related quality of life and visual function in patients undergoing vitrectomy, gas tamponade and cataract surgery for macular hole. Br J Ophthalmol 93(12):1595CrossRefGoogle Scholar
  21. 21.
    Woo JH, Au Eong KG (2008) Macular hole surgery without prone positioning. Eye 22(8):1093–1094CrossRefGoogle Scholar
  22. 22.
    Okamoto F, Okamoto Y, Fukuda S, Hiraoka T, Oshika T (2010) Vision-related quality of life and visual function after vitrectomy for various vitreoretinal disorders. Invest Ophthalmol Vis Sci 51(2):744–751CrossRefGoogle Scholar
  23. 23.
    Chan CW, Wong D, Lam CL, Mcghee S, Lai WW (2009) Development of a Chinese version of the National Eye Institute Visual Function Questionnaire (CHI-VFQ-25) as a tool to study patients with eye diseases in Hong Kong. Br J Ophthalmol 93(11):1431–1436CrossRefGoogle Scholar
  24. 24.
    Wang CW, Chan CL, Jin HY (2008) Psychometric properties of the Chinese version of the 25-item National Eye Institute Visual Function Questionnaire. Optom Vis Sci Off Publ Am Acad Optom 85(11):1091CrossRefGoogle Scholar
  25. 25.
    Le Q, Chen Y, Wang X, Li Y, Hong J, Xu J (2011) Vision-related quality of life in patients with ocular chemical burns. Invest Ophthalmol Vis Sci 52(12):8951CrossRefGoogle Scholar
  26. 26.
    Le Q, Cui X, Xiang J, Ge L, Gong L, Xu J (2014) Impact of conjunctivochalasis on visual quality of life: a community population survey. PLoS ONE 9(10):e110821CrossRefGoogle Scholar
  27. 27.
    Hohberger B, Laemmer R, Adler W, Juenemann AG, Horn FK (2007) Measuring contrast sensitivity in normal subjects with OPTEC 6500: influence of age and glare. Graefe’s Arch Clin Exp Ophthalmol 245(12):1805–1814CrossRefGoogle Scholar
  28. 28.
    Karakus SH, Basarir B, Pinarci EY, Kirandi EU, Demirok A (2013) Long-term results of half-dose photodynamic therapy for chronic central serous chorioretinopathy with contrast sensitivity changes. Eye 27(5):612CrossRefGoogle Scholar
  29. 29.
    Chylack L Jr, Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, Friend J, Mccarthy D, Wu SY (1993) The lens opacities classification system III. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol 111(6):831–836CrossRefGoogle Scholar
  30. 30.
    Mann AL, Bressler SB, Hawkins BS, Holekamp N, Bressler NM (2008) Comparison of methods to identify incident cataract in eyes of patients with neovascular maculopathy: submacular surgery trials report no. 18. Ophthalmology 115(1):127–133CrossRefGoogle Scholar
  31. 31.
    Jr BH (2000) Macular hole surgery with and without internal limiting membrane peeling. Archivos De La Sociedad Española De Oftalmología 107(10):1939–1948Google Scholar
  32. 32.
    Ellis JD, Malik TY, Taubert MAK, Barr A, Baines PS (2000) Surgery for full- thickness macular holes with short-duration prone posturing: results of a pilot study. Eye 14(Pt 3A):307–312CrossRefGoogle Scholar
  33. 33.
    Rayat J, Almeida DRP, Belliveau M, Wong J, Gale J (2011) Visual function and vision-related quality of life after macular hole surgery with short-duration, 3-day face-down positioning. Can J Ophthalmol 46(5):399–402CrossRefGoogle Scholar
  34. 34.
    Roh JH, Sohn HD (2010) Comparison of posterior capsular opacification between a combined procedure and a sequential procedure of pars plana vitrectomy and cataract surgery. Ophthalmologica 224(1):42CrossRefGoogle Scholar
  35. 35.
    Ogura Y, Takanashi T, Ishigooka H, Ogino N (1991) Quantitative analysis of lens changes after vitrectomy by fluorophotometry. Am J Ophthalmol 111(2):179–183CrossRefGoogle Scholar
  36. 36.
    Cheng L, Azen SP, Elbradey MH, Scholz BM, Chaidhawangul S, Toyoguchi M, Freeman WR (2001) Duration of vitrectomy and postoperative cataract in the vitrectomy for macular hole study. Am J Ophthalmol 132(6):881–887CrossRefGoogle Scholar
  37. 37.
    Thompson JT (2004) The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes. Am J Ophthalmol 137(2):250–257CrossRefGoogle Scholar
  38. 38.
    Lahtela U, Ylisoivio J, Palosaari T, Hautala N (2015) Early outcomes of macular hole surgery on visual acuity, retinal anatomy and vision-related quality of life. Acta Ophthalmol 93(5):e402CrossRefGoogle Scholar
  39. 39.
    Duan HT, Chen S, Wang YX, Kong JH, Dong M (2015) Visual function and vision-related quality of life after vitrectomy for idiopathic macular hole: a 12-month follow-up study. Int J Ophthalmol 8(4):764–769PubMedPubMedCentralGoogle Scholar
  40. 40.
    Leonard RE II, Smiddy WE, Flynn H Jr, Feuer W (1997) Long-term visual outcomes in patients with successful macular hole surgery. Ophthalmology 104(10):1648–1652CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key LaboratoryCapital Medical UniversityBeijingChina
  2. 2.Ophthalmology DepartmentBeijing Electric Power HospitalsBeijingChina
  3. 3.Department of Ophthalmology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical CollegeQingdao UniversityYantaiChina

Personalised recommendations