Significance of Preoperative External Limiting Membrane Height on Visual Prognosis in Patients Undergoing Macular Hole Surgery

Geenen, Caspar; Murphy, Declan C; Sandinha, Maria Teresa; Rees, Jon; Steel, David

doi:10.1097/iae.0000000000002137

Cited by 14 publications

(16 citation statements)

References 26 publications

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“…In contrast to the area of the cystoid cavity, the basal and minimum MH size, and the lengths of the ELM, EZ, and CIZ defects were significantly correlated with the postoperative BCVA in our results. These results are www.nature.com/scientificreports www.nature.com/scientificreports/ consistent with the findings of earlier reports 16,21 . Several studies have shown that the length of the outer retinal layer defect can be a predicting factor for the postoperative vision because they are related to the MH size.…”

Section: Discussionsupporting

confidence: 92%

“…There have been many reports describing the relationship between the BCVA and the preoperative morphology determined by OCT in eyes with MH, e.g. the basal and minimum MH size 8,9,15 , the ELM height 16 , and the maximum retinal thickness 10 . Our results showed that the area of the cystoid cavities was correlated with the preoperative BCVA.…”

Section: Discussionmentioning

confidence: 99%

“…It is believed that the cystoid spaces will expand and separate the retinal layer along with the forming of MH, and finally the intraretinal cystoid cavities are observed around the edges of the MH 25,26 . Several studies have reported on the relationships between the VMT and basal MH size and outer retinal elevation 27,28 . The basal MH size and the outer retinal elevation is increased along with the progression of primary MH due to the VMT.…”

Section: Discussionmentioning

confidence: 99%

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Correlations between intraretinal cystoid cavities and pre- and postoperative characteristics of eyes after closure of idiopathic macular hole

Goto

Iwase

Yamamoto

et al. 2020

Sci Rep

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intraretinal cystoid cavities have been detected at the edges of macular holes (MHs) but their clinical characteristics and their relationship to the MH variables have not been determined. We measured the areas of the intraretinal cystoid cavity in 111 eyes with MHs in the OCT images preoperatively. Our results showed that the intraretinal cystoid cavities were located in the Henle fiber layer-outer nuclear layer (HFL-ONL) complex in 106 eyes and in the inner nuclear layer (INL) in 89 eyes. All were resolved after the initial vitrectomy to close the MH. the mean area of the cystoid cavity was greater in the HFL-ONL complex (55.9 ± 42.7 × 10 3 μm 2 ) than in the INL (9.1 ± 9.8 × 10 3 μm 2 ; P < 0.001). The area of the cystoid cavities was significantly correlated with the basal MH size (r = 0.465,P < 0.001), the external limiting membrane height (r = 0.793, P < 0.001), and the maximum retinal thickness (r = 0.757, P < 0.001). The area of the cystoid cavities was significantly correlated with the preoperative best-corrected visual acuity (BCVA; r = 0.361, P < 0.001), but not with the postoperative BCVA or the integrity of any of the outer retinal microstructural bands. the presence of intraretinal cystoid cavities was related to some morphological characteristics, but not to the postoperative BCVA or the restoration of the outer retinal bands.An idiopathic macular hole (MH) is found more commonly in the eyes of middle-aged and older individuals and can cause metamorphopsia and a decrease of the best-corrected visual acuity (BCVA). There are several suggestions on the mechanisms causing the formation of a full-thickness MH. Gass suggested that a MH begins by a tangential traction of the perifoveal vitreous cortex on the foveal retina which results in a dehiscence that progresses to a full-thickness MH 1,2 .Optical coherence tomography (OCT) has enabled clinicians to evaluate the foveal microstructures in eyes with a MH. Recent studies have determined that a MH is initially formed by a perifoveal posterior vitreous detachment (PVD) which causes an anteroposterior vitreomacular traction (VMT) 3-5 .Intraretinal cystoid cavities at the edges of a MH have been recognized in the images obtained by the early OCT devices 6 . These intraretinal hyporeflective spaces, the intraretinal cystoid cavities, are frequently observed around the edges of MHs 7 . However, the area of intraretinal cystoid cavities varies among eyes with a MH, and the clinical features of these eyes have not been quantified.Recent advances in the surgical techniques for closing a MH have improved the anatomical closure rates and the postoperative BCVAs. However, even after a successful closure of a MH, the postoperative BCVA can be unsatisfactory in some cases. To predict the postoperative BCVA, several preoperative OCT features such as the basal and minimum MH size 8,9 and the maximum retinal thickness 10 have been evaluated. Several investigators have reported that the degree of disruption of the microstructures of the photoreceptors in the preoperativ...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Correlations between intraretinal cystoid cavities and pre- and postoperative characteristics of eyes after closure of idiopathic macular hole

Goto

Iwase

Yamamoto

et al. 2020

Sci Rep

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“…Metamorphopsia in patients is the perception deviation of the horizontal or vertical line, and it sometimes may appear before the clinical manifestation of macular disease [33–38]. Patients may sometimes consider metamorphopsia as an unstable condition of vision instead of precise deformations of objects, and they focus better with slightly unconscious eye movements.…”

Section: Metamorphopsiamentioning

confidence: 99%

“…To evaluate metamorphopsia, many functional examinations can be conducted, such as the Amsler grid and the mobile handheld home surveillance devices [57]. The Amsler grid [34, 37, 38, 58] was the first functional test to be evaluated for visual distortion. This test enables simple and fast qualitative assessment of changes in the visual function in the field of view of central 10°, which might appear prior to certain macular diseases or together with the development of these diseases.…”

Section: Metamorphopsiamentioning

confidence: 99%

Idiopathic Macular Hole: A Comprehensive Review of Its Pathogenesis and of Advanced Studies on Metamorphopsia

Chen

Liu

2019

Journal of Ophthalmology

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Vitreous anteroposterior traction is an important factor that affects macular hole (MH) formation at the early stage, and vitreous tangential traction can lead to further hole expansion after hole formation. Recent studies have highlighted the significance of Müller cells for the pathogenesis of MH. Since the advent of MH treatment, success rates for MH closure have significantly improved, as has postoperative visual acuity. However, metamorphopsia, an initial and common symptom of MH, still exists. Metamorphopsia is significantly related to the deterioration of visual quality of life and can be used as an independent index to evaluate visual function before and after surgery. In MH patients, metamorphopsia has different manifestations representing different clinical implications. M-CHARTS, as a new means of inspection, can quantify the degrees of metamorphopsia, and with the development of optical coherence tomography (OCT), layer-by-layer scanning of the retinal structure has become possible. These methods enable detailed analysis of the connections between the degree of metamorphopsia and relevant OCT parameters. Preoperative OCT parameters can be used to evaluate the prognosis of the postoperative visual function of MH patients and are therefore of great significance in guiding the treatment of MH patients.

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Analysis of Macular Pigment Optical Density in Macular Holes with Different Border Phenotypes

Quarta,

Gironi,

Ruggeri

et al. 2024

Ophthalmol Ther

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Introduction We conducted a cross-sectional study to compare macular pigment optical density (MPOD) in eyes with idiopathic macular holes with bumpy (bbMH) and smooth borders (sbMH) and to assess the relation between MPOD and optical coherence tomography findings. Thirty eyes from thirty patients affected by idiopathic macular hole were studied. Methods All patients underwent SD-OCT and macular pigment optical density (MPOD) analysis. Comparison between the two border phenotypes were estimated at baseline, as well as the differences in MPOD, minimum and basal hole diameter, tractional hole index (THI), macular hole index (MHI), diameter hole index (DHI), and ELM integrity metrics between the two groups. Results The mean MPOD was 0.09 ± 0.08 in bbMHs and 0.16 ± 0.11 in sbMHs ( p = 0.010). Correlation analysis between MPOD and minimum hole diameter revealed a negative association (rho = − 0.707, p = 0.008) in bbMH and a positive association (rho = 0.702, p = 0.019) in sbMH. MPOD and basal diameter were negatively correlated in bbMH (rho = − 0.77, p = 0.001) and positively correlated in sbMH (rho = 0.675, p = 0.019). Indeed, MPOD is negatively correlated with THI and MHI in sbMH (rho = − 0.684 p = 0.019; rho = − 0.665 p = 0.019, respectively) and positively correlated in bbMH (rho = 0.593 p = 0.037; rho = 0.658 p = 0.018, respectively). Conclusions MPOD is significantly reduced in bbMHs compared to sbMHs. The two border phenotypes also differ for tractional and tangential indexes, possibly reflecting a different pathogenesis. Further studies are needed to understand the prognostic role of MPOD.

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Significance of Preoperative External Limiting Membrane Height on Visual Prognosis in Patients Undergoing Macular Hole Surgery

Abstract: The ELM height varies widely in idiopathic macular hole. It is higher in eyes where the hole is wider and also when the hole itself is higher. For holes of less than 400 μm in width, a lower ELM height is a strong independent predictor of a good postoperative outcome.

Cited by 14 publications

References 26 publications

Correlations between intraretinal cystoid cavities and pre- and postoperative characteristics of eyes after closure of idiopathic macular hole

Correlations between intraretinal cystoid cavities and pre- and postoperative characteristics of eyes after closure of idiopathic macular hole

Idiopathic Macular Hole: A Comprehensive Review of Its Pathogenesis and of Advanced Studies on Metamorphopsia

Analysis of Macular Pigment Optical Density in Macular Holes with Different Border Phenotypes

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