Abstract：
OBJECTIVE: To define the effect of symptom duration on outcomes in people undergoing surgery for idiopathic full-thickness macular holes (iFTMHs) by means of an individual participant data (IPD) study of randomized controlled trials (RCTs). The outcomes assessed were primary iFTMH closure and postoperative best-corrected visual acuity (BCVA).
CONCLUSIONS: Idiopathic full-thickness macular holes are visually disabling with a prevalence of up to 0.5%. Untreated BCVA is typically reduced to 20/200. Surgery can close holes and improve vision. Symptom duration is thought to affect outcomes with surgery, but the effect is unclear.
METHODS: A systematic review identified eligible RCTs that included adults with iFTMH undergoing vitrectomy with gas tamponade in which symptom duration, primary iFTMH closure, and postoperative BCVA were recorded. Bibliographic databases were searched for articles published between 2000 and 2020. Individual participant data were requested from eligible studies.
RESULTS: Twenty eligible RCTs were identified. Data were requested from all studies and obtained from 12, representing 940 eyes in total. Median symptom duration was 6 months (interquartile range, 3-10). Primary closure was achieved in 81.5% of eyes. There was a linear relationship between predicted probability of closure and symptom duration. Multilevel logistic regression showed each additional month of duration was associated with 0.965 times lower odds of closure (95% confidence interval [CI], 0.935-0.996, P = 0.026). Internal limiting membrane (ILM) peeling, ILM flap use, better preoperative BCVA, face-down positioning, and smaller iFTMH size were associated with increased odds of primary closure. Median postoperative BCVA in eyes achieving primary closure was 0.48 logarithm of the minimum angle of resolution (logMAR) (20/60). Multilevel logistic regression showed for eyes achieving primary iFTMH closure, each additional month of symptom duration was associated with worsening BCVA by 0.008 logMAR units (95% CI, 0.005-0.011, P < 0.001) (i.e., ∼1 Early Treatment Diabetic Retinopathy Study letter loss per 2 months). ILM flaps, intraocular tamponade using long-acting gas, better preoperative BCVA, smaller iFTMH size, and phakic status were also associated with improved postoperative BCVA.
CONCLUSIONS: Symptom duration was independently associated with both anatomic and visual outcomes in persons undergoing surgery for iFTMH. Time to surgery should be minimized and care pathways designed to enable this.
CONCLUSIONS: Idiopathic full-thickness macular holes are visually disabling with a prevalence of up to 0.5%. Untreated BCVA is typically reduced to 20/200. Surgery can close holes and improve vision. Symptom duration is thought to affect outcomes with surgery, but the effect is unclear.
METHODS: A systematic review identified eligible RCTs that included adults with iFTMH undergoing vitrectomy with gas tamponade in which symptom duration, primary iFTMH closure, and postoperative BCVA were recorded. Bibliographic databases were searched for articles published between 2000 and 2020. Individual participant data were requested from eligible studies.
RESULTS: Twenty eligible RCTs were identified. Data were requested from all studies and obtained from 12, representing 940 eyes in total. Median symptom duration was 6 months (interquartile range, 3-10). Primary closure was achieved in 81.5% of eyes. There was a linear relationship between predicted probability of closure and symptom duration. Multilevel logistic regression showed each additional month of duration was associated with 0.965 times lower odds of closure (95% confidence interval [CI], 0.935-0.996, P = 0.026). Internal limiting membrane (ILM) peeling, ILM flap use, better preoperative BCVA, face-down positioning, and smaller iFTMH size were associated with increased odds of primary closure. Median postoperative BCVA in eyes achieving primary closure was 0.48 logarithm of the minimum angle of resolution (logMAR) (20/60). Multilevel logistic regression showed for eyes achieving primary iFTMH closure, each additional month of symptom duration was associated with worsening BCVA by 0.008 logMAR units (95% CI, 0.005-0.011, P < 0.001) (i.e., ∼1 Early Treatment Diabetic Retinopathy Study letter loss per 2 months). ILM flaps, intraocular tamponade using long-acting gas, better preoperative BCVA, smaller iFTMH size, and phakic status were also associated with improved postoperative BCVA.
CONCLUSIONS: Symptom duration was independently associated with both anatomic and visual outcomes in persons undergoing surgery for iFTMH. Time to surgery should be minimized and care pathways designed to enable this.
摘要：
目的：通过一项随机对照试验（RCT）的个体参与者数据（IPD）研究，确定特发性全厚度黄斑裂孔（iFTMHs）手术患者症状持续时间对预后的影响。评估的结果是初次iFTMH闭合和术后最佳矫正视力（BCVA）。
结论：特发性全厚度黄斑裂孔是视力致残的，患病率高达0.5%。未处理的BCVA通常降低到20/200。手术可以闭合孔并改善视力。症状持续时间被认为会影响手术的结果，但效果尚不清楚。
方法：一项系统评价确定了合格的随机对照试验，包括iFTMH患者接受玻璃体切除术伴气体填塞，其中症状持续时间，主iFTMH闭包,记录术后BCVA。在书目数据库中搜索了2000年至2020年之间发表的文章。从符合条件的研究中要求个体参与者数据。
结果：确定了20个合格的随机对照试验。从所有研究中要求数据，并从12个研究中获得，总共代表940只眼。中位症状持续时间为6个月(四分位距，3-10).81.5%的眼睛实现了初次闭合。预测的闭合概率和症状持续时间之间存在线性关系。多水平logistic回归显示，持续时间每增加一个月，闭合几率降低0.965倍（95%置信区间[CI]，0.935-0.996,P=0.026)。内限膜(ILM)剥离,ILM皮瓣使用,更好的术前BCVA，面朝下定位,较小的iFTMH大小与初次闭合几率增加相关.获得初次闭合的眼睛的术后BCVA中位数为最小分辨率角（logMAR）的0.48对数（20/60）。对于达到原发性iFTMH闭合的眼睛，显示了多水平逻辑回归，症状持续时间的每增加一个月与BCVA恶化0.008logMAR单位相关（95％CI，0.005-0.011，P<0.001）（即~1早期治疗糖尿病视网膜病变研究信丢失每2个月)。ILM襟翼,使用长效气体的眼内填塞，更好的术前BCVA，较小的iFTMH尺寸，和phokic状态也与术后BCVA改善相关。
结论：在接受iFTMH手术的患者中，症状持续时间与解剖和视觉结果独立相关。应尽量减少手术时间，并为此设计护理途径。
结论：特发性全厚度黄斑裂孔是视力致残的，患病率高达0.5%。未处理的BCVA通常降低到20/200。手术可以闭合孔并改善视力。症状持续时间被认为会影响手术的结果，但效果尚不清楚。
方法：一项系统评价确定了合格的随机对照试验，包括iFTMH患者接受玻璃体切除术伴气体填塞，其中症状持续时间，主iFTMH闭包,记录术后BCVA。在书目数据库中搜索了2000年至2020年之间发表的文章。从符合条件的研究中要求个体参与者数据。
结果：确定了20个合格的随机对照试验。从所有研究中要求数据，并从12个研究中获得，总共代表940只眼。中位症状持续时间为6个月(四分位距，3-10).81.5%的眼睛实现了初次闭合。预测的闭合概率和症状持续时间之间存在线性关系。多水平logistic回归显示，持续时间每增加一个月，闭合几率降低0.965倍（95%置信区间[CI]，0.935-0.996,P=0.026)。内限膜(ILM)剥离,ILM皮瓣使用,更好的术前BCVA，面朝下定位,较小的iFTMH大小与初次闭合几率增加相关.获得初次闭合的眼睛的术后BCVA中位数为最小分辨率角（logMAR）的0.48对数（20/60）。对于达到原发性iFTMH闭合的眼睛，显示了多水平逻辑回归，症状持续时间的每增加一个月与BCVA恶化0.008logMAR单位相关（95％CI，0.005-0.011，P<0.001）（即~1早期治疗糖尿病视网膜病变研究信丢失每2个月)。ILM襟翼,使用长效气体的眼内填塞，更好的术前BCVA，较小的iFTMH尺寸，和phokic状态也与术后BCVA改善相关。
结论：在接受iFTMH手术的患者中，症状持续时间与解剖和视觉结果独立相关。应尽量减少手术时间，并为此设计护理途径。
