Title

PREDICTING MACULAR HOLE CLOSURE AFTER ILM PEELING USING OPTICAL COHERENCE TOMOGRAPHY

Introduction

The purpose of this paper is to study the role of preoperative spectral-domain optic coherence tomography (OCT) as a predictor of macular hole (MH) closure after pars-plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling.

Methods

Preoperative OCT scans from patients with symptomatic MH were analyzed. MH height, minimum linear dimension and base-diameter were measured, and the macular hole index (MHI: base-diameter/height) and the newly proposed double diameter index (D+D: minimum linear dimension+base-diameter) were calculated. The leverage of these parameters on postoperative MH closure was calculated by multivariate nominal logistic model. Additionally, preoperative best-corrected visual acuity, duration of symptoms, age, and gender were also considered as potential effects in the analysis.

Results

A total of 65 patients completed 48-week follow-up. Mean (± SE) preoperative BCVA (logMAR) was 0.91 ± 0.04 and improved significantly to 0.59 ± 0.05 (P<0.001) after 48 weeks. MH closure was observed on 49 out of 65 cases (75%). Mean preoperative MHI was 0.46 ± 0.02; (height = 444.5 ± 7.7 µm; base-diameter = 1057.6 ± 41.1 µm; and size = 475.0 ± 25.1 µm). There was a significant influence of MH base-diameter, D+D and MHI on MH closure (P = 0.0005). We estimated that a high probability of macular closure could be expected for OCTs showing base diameter smaller than 884.2 µm ± 39.0 µm, and this likelihood decreases from this point at ratio of 11.16 % ± 0.84 % / 100 µm.

Discussion

It is possible to estimate the probability of macular closure using pre-operative measurements on OCT images. These estimates could be used to improve patient and surgeon awareness of anatomical success likelihood following traditional ILM peeling. Data from larger cohorts should be used to confirm these results.

Keywords

Vitrectomy; Macular Hole Closure, SD-OCT, Macular Surgery; Macular Hole

Area

SURGICAL CASE

Authors

Tomás Teixeira-Pinto, Marcelo M Esperandio, Karlos I S Viana, André Messias, Rodrigo Jorge