Título

SPECTRAL DOMAIN OPTICAL COHERENCE FINDINGS PREDICTIVE OF VISUAL IMPROVEMENT IN A PROSPECTIVE CLINICAL TRIAL OF MACULAR HOLE SURGERY

Introdução / Purpose

To verify SD-OCT findings related to best-corrected visual acuity (BCVA) improvement in a prospective randomized trial of macular hole surgery.

Material e Método / Methods

Data from a prospective randomized trial of macular hole 65 patients (65 eyes) with symptoms without significant cataract was analyzed to check for preoperative and postoperative findings that would predict BCVA improvement. Briefly, patients were randomized into 2 groups : A (PHACO+PPV) and B (PPV with deferred PHACO). In group B,phaco could be performed at any time postoperatively if the patient had any cataract that would prevent valid exams or any decrease in visual acuity attributable to cataract.SD-OCT parameters analyzed:preoperatively:MH height(H),internal base(IB) and external base(EB) sizes;postoperatively:central subfield thickness.

Resultados / Results

65 patients completed the 48-week visit and were included (Group: A:33; Group B:32).Macular hole closure rate was 72,73% and 75% in A and B (p=0.834 Fisher's test). Mean±SEM Log MAR BCVA significantly improved in both groups(p<0.05): from 0.96 ± 0.04 and 0.95 ± 0.05 (p=0,870) at baseline to 0.60 ± 0.30 and 0.58 ± 0.35 (p=0,842) at week 48,in A and B respectively. Initial Log MAR BCVA has a 53% power to predict final visual acuity(p <0.0001).At baseline,mean MH external base,internal base and height (μm) ± SEM were 1013,96 ± 350,76, 471.10 ± 197.21 and 436.50 ± 67.64,respectively. The highest correlation with visual acuity improvement was the external base size which had a correlation power of 64%(p<0.0001) followed by the internal base size with a 59% correlation(p<0.0001)and height with 34%(p<0.0052). Postoperatively,CSFT after macular hole closure had a correlation power with BCVA improvement of 31%(p=0.03).

Discussão e Conclusões / Discussion

In order of predictive power, SD_OCT findings related to visual acuity improvement after macular hole surgery are:preoperative macular hole external base, internal base and height sizes; postoperatively: CSFT in closed macular holes.

Palavras Chave

vitrectomy, visual acuity; macular hole