Vitrectomy and phacoemulsification—to combine or not in patients with a macular hole

Introduction: Macular hole and cataract are pathologies that often occur simultaneously in elderly patients and lead to a progressive decrease in visual acuity and worsen metamorphopsia. The incidence of macular holes varies in different populations, with an average of about 3.3 per 1,000 people. It affects to a greater extent the female sex (F:M = 3:1), usually over sixty years. The causes of a macular hole are many, patients with high myopia are a risk group, trauma is a risk factor at any age, as well as the changes that occur with the vitreous body with age. Aim: The present study aimed to evaluate the visual and anatomical outcomes as well as the quality of life of patients who underwent combined macular hole and cataract surgery. Methods: In the present study, 20 patients diagnosed with macular hole and cataract were included, each patient underwent a complete ophthalmological examination with highly specialized equipment. The Early Treatment Diabetic Retinopathy Study (ETDRS) was used as the gold standard for visual acuity determination, and optical coherence tomography (OCT) was used for diagnosis, macular hole size determination, and postoperative follow-up of anatomical results. Patients underwent cataract phacoemulsification with intraocular lens implantation and pars plana vitrectomy for macular hole. All eyes were injected with expanding gas. Results: Qualitative and quantitative results were followed in 20 patients, of which 14 men and 6 women with a mean age of 63.5 years. Anatomical closure of the macular hole on OCT examination was found in 100% of patients. Complications were not registered during the postoperative period. All patients were followed up at the first and second week, first, second, third, and sixth month after surgery. Visual acuity increased by up to 42% at the time of follow-up. Conclusion: The combined surgical approach for the treatment of macular hole and lens opacity, leads to an earlier visual outcome and less psychoemotional stress for the patient.