Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome

Abstract

Background: To investigate the association between iOCT feature in macular hole (MH) surgery and the restoration of the retina microstructure and visual outcomes. Methods: This was a case series study including fifty-three eyes of 53 patients with macular hole were recruited. According to the morphological characteristics of the hole edge as imaged by iOCT after ILM peeling, all patients were divided into three groups: fovel flap group, hole-door group, and negative group. The restoration of the retina microstructure and postoperative visual outcomes of the MH surgery were compared between these groups. Results: All of the eyes had MH closure after vitrectomy. The postoperative BCVA was significantly improved compared with the preoperative BCVA (P<0.001). Based on the features of the hole edge as reveal by iOCT, the negative group included 24 eyes, the fovea flap group included 14 eyes, and the hole-door group included 15 eyes. The hole-door group and foveal flap group had significantly better final visual acuity and postoperative restoration of the ELM than the negative group (P=0.002, P=0.012). For the group in which the MHD was ≤400 μm, there were no significant differences in ELM restoration, EZ restoration, or BCVA among the three groups (P=0.516 and P=0.179 respectively). For the MHD >400-μm group, the hole-door group and fovea flap group had significantly better final visual acuity and restoration of ELM than the negative group (P=0.013, P=0.005). Conclusion: This study describes a novel intraoperative sign using iOCT. This sign can provide useful predictive information for postoperative restoration of the retinal microstructure and visual outcomes of MHs, especially large ones

Prognostic Factors for Visual Outcomes in Closed Idiopathic Macular Holes after Vitrectomy: Outcomes at 4 Years in a Monocentric Study

“…Minimum diameter of MH (equivalent to MH size) is one of the most studied parameters. Other parameters include hole height and inner segment/outer segment junction defect length as well as ratios such as the macular hole index (MHI) [26]. In our study, we identified the presence of elevated edges on preoperative OCT as a predictive factor of final VA ≥70 ETDRS letters.…”

“…In our study, we identified the presence of elevated edges on preoperative OCT as a predictive factor of final VA ≥70 ETDRS letters. A recent study by Tao et al investigated the impact of postoperative hole edge configurations on visual outcomes and found that MH morphologies with extra flaps of tissue (n � 14) had significantly better final VA and postoperative restoration of ELM than MH without any specific configuration (n � 24) (p � 0.012) [26]. However, to our knowledge, no studies have looked at elevated MH edge as a preoperative factor.…”

Clinical applications for intraoperative optical coherence tomography: a systematic review

“…Eyes with the hole-doorsign had a 100% rate of closure without an neurosensory defect compared to 60% of the eyes without the hole-door-sign [61]. The studies of Inoue et al and Tao et al confirmed the predictive value of the hole-door-sign for macula hole closure, however, the authors reported contradicting results regarding the postoperative visual acuity in eyes with the hole-door-sign [62,63].…”