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Zabrina Abdool, Jan Provis, William Campbell, Alex Hunyor, Ian McAllister, Rohan Essex; Structured Method for Assessing Macular Holes by OCT and Correlations with Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3849.
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© ARVO (1962-2015); The Authors (2016-present)
To develop an objective method to assess pre- and post-operative macular holes (MH) using optical coherence tomography (OCT) in a single surgeon cohort, and to explore the association between OCT parameters and visual outcomes.
Horizontal OCT B-scans at baseline and 3 months post-operative were analysed in 50 eyes undergoing surgery for idiopathic macular hole. Visual acuity (VA) was assessed pre-operative and at 3 months post-operative using VA letter score. In addition to various linear measurements, the cross-sectional area of the pre- and post-operative central 3mm macular region was measured, sub-divided into 4 layers. Layer 1: Inner limiting membrane (ILM) to the outer border of the inner plexiform layer (IPL); Layer 2: from layer 1 to the mid-line of the outer plexiform layer (OPL); Layer 3: from layer 2 to the external limiting membrane (ELM); and Layer 4: from layer 3 to the inner-border of the retinal pigment epithelium (RPE). The presence of inner nuclear layer (INL) or Henle’s layer cysts was noted. Correlations between change in area, presence of cysts and change in vision were calculated.
Post-operatively, the percentage change in cross-sectional area of layers 1 thru 4 were -4%, -7%, -18% and +6% respectively. Change in layer 2 (the layer containing the inner nuclear layer (INL)) was significantly negatively correlated to change in vision (i.e. better improvements in visual acuity with greater loss of area, P=0.028). No significant correlation was observed between change in vision and change in the other layers. The presence of INL cysts pre-operatively, but not of Henle’s layer cysts, was significantly correlated with a greater postoperative improvement of vision (P = 0.013).
Conclusions: The pre-operative presence of inner retinal cysts, and a decrease in INL cross-sectional area at 3 months postoperative were associated with greater improvements in VA following macular hole surgery. In contrast, although outer retinal cross-sectional area, decreased more following surgery, this was not associated with greater visual acuity improvements.
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