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

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.