The Importance of Anatomic Configuration and Cystic Changes in Macular Hole: Predicting Surgical Success with a Different Approach

Abstract

This study aimed to de ne novel metrics for the area of the macular hole (MH) and the cysts placed around the hole using an optical coherence tomography (OCT) device. MethodsThis retrospective, cross-sectional study was conducted with 58 eyes of 56 patients. The patients were divided into two groups according to anatomic closure after surgery. The novel metrics including macular hole index (MHI), tractional hole index (THI), and (hole forming factor) HFF, macular hole area (HA), the cystoid space areas in the inner retinal layers (CA), and the cyst hole area index (CHAI) were calculated.Correlation of the CA, the HA, and the CHAI with other indexes was assessed. Receiver operating characteristic (ROC) curves and cut-off values were derived for indexes predicting type 1 or type 2 closures. ResultsThe CA positively correlated with the base MH size and the maximum MH height (p <0.001, p <0.001, respectively). The HA showed a positive correlation with basal MH size, minimum MH size, and maximum MH height (p <0.001, p <0.001, p <0.001, respectively). CHAI was positively correlated with minimum MH size. (p = 0.02). CHAI and HA were negatively correlated with postoperative BCVA (p= 0.003, p=0.006, respectively). ROC curve analysis showed that MHI, THI, and HFF predicted type 1 closure; on the other hand, CHAI and HA predicted type 2 closures. Conclusions MHI and our novel index CHAI, which can be calculated without any additional software, could successfully predict type 1 and type 2 closures, respectively. Key MessagesMHI, which re ects the height of the macular hole, is the most important biomarker with high sensitivity and speci city in predicting type 1 closure. Our novel index, CHAI, obtained by dividing the macular hole area by the cystoid space areas in the inner retinal layers, is a strong predictor for type 2 closure. The presence of cystoid space areas in the inner retinal layers emerges as a factor preventing Type 2 closure.

Novel Artificial Intelligence-Based Assessment of Imaging Biomarkers in Full-Thickness Macular Holes: Preliminary Data from a Pivotal Trial

“…The improvement in visual acuity after surgery is attributed to the reduction of retinal cystic fluid, as significant functional retinal tissue remains intact [35]. Ozturk et al conducted an analysis of cyst and MH dimensions, revealing a moderate negative correlation with postoperative BCVA [36]. Similarly, Nair et al observed that the sizes of parafoveal intraretinal pseudocysts were linked to a lower closure rate and diminished postoperative BCVA [37].…”

Etiologies and clinical characteristics of macular hole: An 8-year, single-center, retrospective study

“…Both IMH and MMH are complications of posterior vitreous detachment (PVD), which is the consequence of the interaction between vitreous liquefaction and progressive weakening of vitreoretinal adhesion. [18,19] In general, the posterior vitreous cortex initially detaches at the paramacular area and extends the perifoveal area and then to the optical disc. Finally, complete PVD develops, and this inevitable process changes with age.…”

“…Finally, complete PVD develops, and this inevitable process changes with age. [18][19][20][21] IMH is caused by vitreomacular traction, which is characterized by aberrant PVD and accompanied by anatomic distortion of the fovea, whereas secondary MH is caused by pathologies other than vitreomacular traction. [1] Axial elongation and the formation of posterior scleral staphyloma in high myopia accelerate vitreous liquefaction and increase its instability, resulting in abnormal PVD that is more likely to progress to MH; the greater the degree of refraction and the longer the AL, the earlier the PVD occurs.…”