Full-Thickness Macular Hole: Are Supra-RPE Granular Deposits Remnants of Photoreceptors Outer Segments? Clinical Implications

Govetto, Andrea; Bacherini, Daniela; Romano, Mario R.; Matteucci, Martina; Lucchini, Sara S.; Cifarelli, Lorenzo; Dragotto, Francesco; Cereda, Matteo Giuseppe; Parrulli, Salvatore; Staurenghi, Giovanni; Giansanti, Fabrizio; Virgili, Gianni; Bottoni, Ferdinando; Radice, Paolo

doi:10.1016/j.ajo.2022.09.005

Cited by 14 publications

(22 citation statements)

References 27 publications

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“…The supra-RPE granular deposits in MHs, also called as RPE protrusions [8, 9] or proliferation [10], are frequently observed in eyes with a larger hole size and are associated with a worse functional and anatomical postoperative recovery [4, 8–10]. Its origin remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…It was speculated that these hyper-reflective spots might originate from the proliferating and migrating RPE cells [8–10] or indicate an early sign of photoreceptor damage [4, 11, 12] due to photoreceptor detachment and subsequent RPE dysfunction. According to Govetto et al [4], the incidence of supra-RPE granular deposits was significantly higher in eyes with bumpy borders compared with those with smooth borders (90/91, 98.9% vs. 31/58, 53.4%). They hypothesized that these deposits represented the remnants of disrupted photoreceptor that fell off from the bumpy border and lied over RPE [4].…”

Section: Discussionmentioning

confidence: 99%

“…Preoperatively, the morphology of MH borders and the presence of supra-RPE granular deposits were qualitatively determined. The MH morphology was classified based on Govetto et al [4]: smooth morphology, MH with an even and regular border and no distinct lumps or indentations at the MH border (shown in Fig. 1a); bumpy morphology, MH with an uneven, irregular surface with evident lumps or indentations at the MH border (shown in Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Advances of OCT images have markedly improved our understanding on retinal microstructure. On SD-OCT images, the bumpy MH morphology [4], also known as outer segment (OS) defect in the fluid cuff [5], was considered as a deep and potentially irreversible photoreceptor disruption [4, 5]. It was hypothesized that the photoreceptors disruption at the MH edge may result from a combination of metabolic and mechanical process [4]: lack of metabolites and oxygen due to detachment of photoreceptors from retinal pigment epithelium (RPE), where photoreceptors receive glucose, nutrients, and oxygen from the choroidal circulation; wall shear stress from vitreous dynamics, which is caused by saccadic eye movements.…”

Section: Introductionmentioning

confidence: 99%

“…On SD-OCT images, the bumpy MH morphology [4], also known as outer segment (OS) defect in the fluid cuff [5], was considered as a deep and potentially irreversible photoreceptor disruption [4, 5]. It was hypothesized that the photoreceptors disruption at the MH edge may result from a combination of metabolic and mechanical process [4]: lack of metabolites and oxygen due to detachment of photoreceptors from retinal pigment epithelium (RPE), where photoreceptors receive glucose, nutrients, and oxygen from the choroidal circulation; wall shear stress from vitreous dynamics, which is caused by saccadic eye movements. Before surgery, the bumpy MH morphology was associated with a large dark area on preoperative AO-SLO images [5], a high frequency of supra-RPE granular deposits [4], a large MH aperture [4], and a poor best-corrected visual acuity (BCVA) [4].…”

Section: Introductionmentioning

confidence: 99%

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Photoreceptor Outer Segment Loss at the Macular Hole Border: Clinical Characteristics and Surgical Prognosis

Qi,

Yu,

Yang

et al. 2023

Ophthalmic Res

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Introduction: During macular hole (MH) formation, the vitreofoveal traction may lead to foveal neural tissue avulsion and consequent photoreceptor loss. However, the clinical significance of the photoreceptor outer segment disruption at the MH border remains unclear. This study aims to investigate the clinical features and surgical outcomes of MHs with photoreceptor outer segment disruption at the MH border. Methods: This study retrospectively reviewed 86 eyes from 85 patients who underwent vitrectomy combined with internal limiting membrane peeling for idiopathic MHs. Baseline and postoperative best-corrected visual acuity (BCVA) and foveal microstructure on optical coherence tomography images were compared between eyes with smooth and bumpy morphology, the latter of which was defined as those with an uneven and irregular surface with evident lumps and indentations at the MH border. Results: The bumpy morphology was identified in 59 of 86 eyes (68.9%). At baseline, eyes with a bumpy MH morphology had a significantly larger minimum linear diameter (P = 0.043), a longer external limiting membrane defect (P = 0.013), and a worse baseline BCVA (P = 0.017) than those with a smooth morphology. Postoperatively, in a multivariate regression model adjusting preoperative confounding effects, eyes with bumpy borders were associated with a longer ellipsoid zone defect (P = 0.006) and a thinner central fovea (P = 0.002) at 1 month, and a thinner central fovea (P = 0.005) and a worse BCVA (P = 0.015) at 10 months. Conclusion: A severe photoreceptor outer segment loss is common at the MH border, which represents a chronic pathogenic process and may be an independent predictor for an incomplete photoreceptor recovery and worse long-term visual outcomes after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Photoreceptor Outer Segment Loss at the Macular Hole Border: Clinical Characteristics and Surgical Prognosis

Qi,

Yu,

Yang

et al. 2023

Ophthalmic Res

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Choroidal hypertransmission width on optical coherence tomography: a prognostic biomarker in idiopathic macular hole surgery

Alkabes,

Rabiolo,

Govetto

et al. 2024

Graefes Arch Clin Exp Ophthalmol

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Purpose To test the hypothesis that optical coherence tomography (OCT) choroidal hypertransmission width (CHW) is a prognostic biomarker in idiopathic macular hole (MH) surgery Methods Retrospective cohort study of consecutive patients undergoing successful pars plana vitrectomy for idiopathic MH. We collected demographic, clinical, and OCT variables at the preoperative and last available visits. Two investigators assessed the following OCT parameters: MH minimum diameter, base diameter, CHW, ellipsoid zone, and external limiting membrane status (absent vs. present). Delta CHW was calculated as the difference between CHW and MH minimum diameter. Linear models were used to investigate factors associated with postoperative best-corrected visual acuity (BCVA) and BCVA change. Results Thirty-six eyes (36 patients) with a median (interquartile range (IQR)) follow-up of 9 (8–11) months were included. The median BCVA (IQR) improved from 0.75 (1–0.6) logMAR preoperatively to 0.2 (0.6–0.1) logMAR at the last visit (p < 0.001). Preoperative MH minimum diameter (for a 10-μm increase, estimate (standard error (SE)): 0.009 (0.003) logMAR, p = 0.003), base diameter (for a 10-μm increase, 0.003 (0.001) logMAR, p = 0.032), CHW (for a 10-μm increase, 0.008 (0.002) logMAR, p < 0.001), and delta CHW (for a 10-μm increase, 0.013 (0.005) logMAR, p = 0.009) were significantly associated with postoperative BCVA. The proportion of variance explained was the highest for MH CHW (R2 0.35), followed by minimum MH diameter (R2 0.24), delta CHW (R2 0.19), and MH base diameter (R2 0.14). None of the study variables was associated with delta BCVA. Conclusion Preoperative CHW is associated with postoperative visual acuity in patients undergoing successful idiopathic MH surgery and may be a useful OCT prognostic biomarker.

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Prediction of long-term visual outcome of idiopathic full-thickness macular hole surgery using optical coherence tomography parameters that estimate potential preoperative photoreceptor damage

Bajdik,

Vajas,

Kemenes

et al. 2024

Graefes Arch Clin Exp Ophthalmol

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Purpose To identify optical coherence tomography (OCT) parameters that predict postoperative best corrected visual acuity (BCVA) and are based on recent understanding of the pathomechanism of idiopathic full thickness macular hole (iFTMH) formation and closure. Methods A retrospective consecutive case series of patients who had macular hole (MH) surgery at our institution between 2016 and 2022 was performed. 32 eyes of 30 patients were selected with at least 12 months of follow-up, closed MH and good quality OCT at each visit. Univariate correlation analysis, multiple logistic regression with forward stepwise selection, and Akaike’s Information Criterion (AIC) were used to identify the best predictors for postoperative BCVA at 6 and 12 months (M), and final (≥ 12 M) visits, and a new OCT index was created. Abilities of best models/indices to predict < 0.30 logMAR (> 20/40) BCVA were compared to macular hole index (MHI) using the area under the receiver operating curve (AU-ROC) analysis. Results Statistical analysis revealed base diameter (B) (6 M), preoperative BCVA and B (12 M) and smaller ELM-GCL distance (A), and B (final visit) as predictors for postoperative BCVA. AU-ROC analysis indicated greatest AUC at 6 M for MHI and B (0.797, p = 0.004 and 0.836 p = 0.001, respectively) and for the new A/B index at 12 M and final visit (0.844, p = 0.002 and 0.913, p = 0.003, respectively). Conclusion Our study suggests that MHI and B can be useful predictors of short term BCVA while the new A/B index that incorporates OCT parameters indicating potential preoperative photoreceptor damage may be a good predictor for long term postoperative BCVA. Our findings support the theory that initial hole formation mechanisms and photoreceptor damage define visual prognosis.

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Full-Thickness Macular Hole: Are Supra-RPE Granular Deposits Remnants of Photoreceptors Outer Segments? Clinical Implications

Cited by 14 publications

References 27 publications

Photoreceptor Outer Segment Loss at the Macular Hole Border: Clinical Characteristics and Surgical Prognosis

Photoreceptor Outer Segment Loss at the Macular Hole Border: Clinical Characteristics and Surgical Prognosis

Choroidal hypertransmission width on optical coherence tomography: a prognostic biomarker in idiopathic macular hole surgery

Prediction of long-term visual outcome of idiopathic full-thickness macular hole surgery using optical coherence tomography parameters that estimate potential preoperative photoreceptor damage

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