Predicting visual success in macular hole surgery

Gupta, Bhaskar; Laidlaw, D A H; Williamson, Tom H.; Shah, Shreya; Wong, Roger; Wren, Siobhan

doi:10.1136/bjo.2008.153189

Cited by 106 publications

(84 citation statements)

References 15 publications

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“…31 Other factors that could serve as prognostic factors for postoperative visual outcome have been investigated. Some previous reports demonstrated significant correlations of age, preoperative visual acuity, MH size, and central foveal thickness with postoperative visual outcome, [32][33][34][35][36] whereas other series showed contradictory findings. 2,22 A possible reason for these discrepancies may be related to the ELM's potential to recuperate.…”

Section: Discussionmentioning

confidence: 80%

External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

Landa

Gentile

Garcia

et al. 2011

Eye

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Purpose To investigate the relationship between postoperative visual acuity and integrity of the external limiting membrane (ELM) and inner segment-outer segment (IS-OS) junction layers, using spectral domain optical coherence tomography (SD-OCT), in eyes with macular holes (MHs) following surgical repair. Methods Medical charts of MH-operated cases were retrospectively identified and reviewed. The primary outcome measures were best-corrected visual acuity (BCVA) and the status of the ELM and IS-OS lines, using SD-OCT, at 6 weeks and 6 months postoperatively. Results Sixty-two eyes of 62 patients were included. At 6 weeks following surgery, out of 56 (90.3%) eyes with successful MH closure: 0 eyes showed the combination of disrupted ELM and continuous IS-OS layers; 7 eyes (12.5%) demonstrated continuity of both ELM and IS-OS (ELM c /IS-OS c group); 29 eyes (51.8%) had continuous ELM with discontinuous IS-OS layers (ELM c /IS-OS d group); and 20 eyes (35.7%) had discontinuities in both the layers (ELM d /IS-OS d group). The ELM d /IS-OS d group had the lowest visual gain at 6 months (P ¼ 0.03). At 6 months, a restoration of the integrity of IS-OS layer was observed in 51.7% eyes in the ELM c /IS-OS d group and in 5% in the ELM d /IS-OS d group (P ¼ 0.001). Conclusions When both ELM and IS-OS layers showed disruptions 6 weeks postoperatively, a significantly worse BCVA was measured at 6 months, compared with the eyes with only IS-OS disruptions, detected 6 weeks following surgery. The integrity of the ELM layer appears to be a critical factor for the restoration of the photoreceptor layer and for predicting a successful visual outcome following MH repair.

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Section: Discussionmentioning

confidence: 80%

External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

Landa

Gentile

Garcia

et al. 2011

Eye

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“…Among the basal hole parameters, maximal linear dimension (MLD) has been known to be one of the most important OCT parameters in predicting surgical outcomes. 24,31 Currently, 400 μm has been the size limit in defining 'small and medium' or 'large' sized macular holes. 32 Previously, several other methods of hole size measurements that may reflect tangential or anterior posterior tractional force and/or retinal hydration have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…21,22 In addition, for determination of preoperative tissue defects, identification of the foveal morphology before hole development is necessary. 7,23,24 However, in most cases the prehole foveal morphology may not be known, although it is well established that foveal morphology between eyes of an individual shows strong symmetry. 25 To assess preoperative morphologic factors that reflect the extent of foveal tissue defects, we compared the preoperative morphologic features and postoperative visual outcomes using OCT. We used the fellow eye's foveal topographic parameters for evaluating individual foveal morphologic variations based on the fact that similar morphologic correlations exist between both eyes.…”

Section: Introductionmentioning

confidence: 99%

Determination of macular hole size in relation to individual variabilities of fovea morphology

Shin

Chu

Hong

et al. 2015

Eye

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Purpose To determine the preoperative anatomic factors in macular holes and their correlation to hole closure. Methods Forty-six eyes with consecutive unilateral macular hole who had undergone surgery and followed up for at least 6 months were enrolled. Optical coherence tomography images and best-corrected visual acuity (BCVA) within 2 weeks prior to operation and 6 months after surgery were analyzed. The maximal hole dimension, foveal degeneration factors (inner nuclear layer cysts, outer segment (OS) shortening) and the widest foveolar floor size of the fellow eyes were measured. For overcoming preoperative individual variability of foveal morphology, an 'adjusted' hole size parameter (the ratio between the hole size and the fellow eye foveolar floor size) was used based on the fact that both eyes were morphologically symmetrical. Results Mean preoperative BCVA (logMAR) was 1.03 ± 0.43 and the mean postoperative BCVA was 0.50 ± 0.38 at 6 months. Preoperative BCVA is significantly associated with postoperative BCVA (P = 0.0002). The average hole diameter was 448.9 ± 196.8 μm and the average fellow eye foveolar floor size was 461.3 ± 128.4 μm. There was a correlation between hole diameter and the size of the fellow eye foveolar floor (Pearson's coefficient = 0.608, Po0.0001). The adjusted hole size parameter was 0.979 ± 0.358 (0.761-2.336), which was a strong predictor for both anatomic (P = 0.0281) and visual (P = 0.0016) outcome. Conclusion When determining the extent of preoperative hole size, we have to take into consideration the foveal morphologic variations among individuals. Hole size may be related to the original foveal shape, especially in relation to the centrifugal retraction of the foveal tissues.

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“…The initial closure rate in the ocriplasmin group is significantly lower, and median final visual acuity falls slightly below the vitrectomy group. Final visual acuity in the ocriplasmin group may suffer due to an initial decrease in visual acuity and an increase in both MLD and BD in unclosed FTMHs (Gupta et al 2009;Wakely et al 2012). Thus, it is important to establish whether ocriplasmin treatment results in non-inferior final visual acuity.…”

Section: Referencesmentioning

confidence: 99%

Is visual acuity non‐inferior in full‐thickness macular holes treated with ocriplasmin?

Alberti

Cour

2015

Acta Ophthalmologica

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Predicting visual success in macular hole surgery

Abstract: The results provide a simple and clinically useful model to employ when counselling patients on macular hole surgery.

Cited by 106 publications

References 15 publications

External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

Determination of macular hole size in relation to individual variabilities of fovea morphology

Is visual acuity non‐inferior in full‐thickness macular holes treated with ocriplasmin?

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