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

International Ophthalmology volume 39, pages 2775–2783 (2019)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. La CM, Friis J (2002) Macular holes: classification, epidemiology, natural history and treatment. Acta Ophthalmol Scand 80(6):579

    Article  Google Scholar 

  2. Kelly NE, Wendel RT (1991) Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol 109(5):654

    CAS  Article  Google Scholar 

  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):1697–1701

    Article  Google Scholar 

  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):1392

    CAS  Article  Google Scholar 

  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):1328–1335

    CAS  Article  Google Scholar 

  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):661–666

    Article  Google Scholar 

  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):387–391

    Article  Google Scholar 

  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):48

    CAS  Article  Google Scholar 

  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):2001–2005

    Article  Google Scholar 

  10. Stein JD (2004) Disparities between ophthalmologists and their patients in estimating quality of life. Curr Opin Ophthalmol 15(3):238–243

    Article  Google Scholar 

  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):1952–1959

    Article  Google Scholar 

  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):941–948

    Article  Google Scholar 

  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):1303–1307

    Article  Google Scholar 

  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):733–740

    CAS  Article  Google Scholar 

  15. Kymes SM, Walline JJ, Zadnik K, Gordon MO (2004) Quality of life in keratoconus. Am J Ophthalmol 138(4):527–535

    Article  Google Scholar 

  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):85–90

    Article  Google Scholar 

  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):559

    CAS  Article  Google Scholar 

  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):995–1002

    Article  Google Scholar 

  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):481

    Article  Google Scholar 

  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):1595

    CAS  Article  Google Scholar 

  21. Woo JH, Au Eong KG (2008) Macular hole surgery without prone positioning. Eye 22(8):1093–1094

    CAS  Article  Google Scholar 

  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):744–751

    Article  Google Scholar 

  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):1431–1436

    CAS  Article  Google Scholar 

  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):1091

    Article  Google Scholar 

  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):8951

    Article  Google Scholar 

  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):e110821

    Article  Google Scholar 

  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):1805–1814

    Article  Google Scholar 

  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):612

    CAS  Article  Google Scholar 

  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):831–836

    Article  Google Scholar 

  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):127–133

    Article  Google Scholar 

  31. Jr BH (2000) Macular hole surgery with and without internal limiting membrane peeling. Archivos De La Sociedad Española De Oftalmología 107(10):1939–1948

    Google Scholar 

  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):307–312

    Article  Google Scholar 

  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):399–402

    Article  Google Scholar 

  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):42

    Article  Google Scholar 

  35. Ogura Y, Takanashi T, Ishigooka H, Ogino N (1991) Quantitative analysis of lens changes after vitrectomy by fluorophotometry. Am J Ophthalmol 111(2):179–183

    CAS  Article  Google Scholar 

  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):881–887

    CAS  Article  Google Scholar 

  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):250–257

    Article  Google Scholar 

  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):e402

    Article  Google Scholar 

  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):764–769

    PubMed  PubMed Central  Google Scholar 

  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):1648–1652

    Article  Google Scholar 

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Author information

Affiliations

  1. Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Sciences Key Laboratory, Capital Medical University, Beijing, China

    Yi Wang, Xida Liang, Meng Gao & Wu Liu

  2. Ophthalmology Department, Beijing Electric Power Hospitals, Beijing, China

    Ju Liu

  3. Department of Ophthalmology, Yantai Yuhuangding Hospital, Affiliated Hospital of Medical College, Qingdao University, Yantai, Shandong, China

    Limei Liu

Authors
  1. Yi Wang
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  2. Xida Liang
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  3. Meng Gao
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  4. Ju Liu
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Correspondence to Wu Liu.

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Wang, Y., Liang, X., Gao, M. et al. Vision-related quality of life after pars plana vitrectomy with or without combined cataract surgery for idiopathic macular hole patients. Int Ophthalmol 39, 2775–2783 (2019). https://doi.org/10.1007/s10792-019-01124-6

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  • DOI: https://doi.org/10.1007/s10792-019-01124-6

Keywords

  • Macular hole
  • VR-QOL
  • Vitrectomy
  • Cataract