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Sumit Sharma, David Xu, Peter K. Kaiser, Rishi P. Singh, Jonathan E. Sears, Daniel F. Martin, Sunil K. Srivastava, Justis P. Ehlers; Spectral Domain Optical Coherence Tomography Based Predictors of Visual Acuity Outcomes in Full Thickness Macular Hole Repair Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5218.
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To identify features of pre-operative spectral domain optical coherence tomography (SDOCT) scans that predict the long-term visual acuity (VA) improvement following macular hole (MH) surgery.
This is a retrospective, interventional, consecutive case series of eyes with idiopathic MH who underwent vitrectomy for MH repair. Inclusion criteria included preoperative SDOCT on the Cirrus HD-OCT (Carl Zeiss Meditec) and at least 12 month follow-up. All eyes underwent dilated ophthalmoscopic exam, SDOCT, and protocol ETDRS VA (converted to logMAR), preoperatively as well as at 6 and 12 months postoperatively. Correlation analysis was conducted between VA at baseline and one year with eight preoperative OCT parameters: manually measured MH nasal height, MH temporal height, MH minimum width, MH base width, total width of the inner segment (IS) outer segment (OS) defect, distance of IS/OS defect to temporal aspect of the MH, distance of IS/OS defect to nasal aspect of the MH and a novel automated computation of MH volume. MH volume was calculated using a custom algorithm for MH segmentation and volumetric calculation.
Data from 23 eyes from 23 patients were included. All had successful closure of the macular hole. The preoperative VA and the length of the IS/OS defect on SDOCT preoperatively were the only statistically significant predictors for change in VA one year after surgical repair. MH volume was able to be successfully calculated on all eyes; however MH volume was not correlated with improvement in VA. None of the other manual OCT characteristics that were reviewed were correlated with improvement of VA at one year.
The preoperative length of the IS/OS defect was the strongest predictor for VA improvement one year after successful surgical repair. This suggests that despite the macular hole size the appearance of the IS/OS segments should be evaluated by SDOCT to predict the likelihood of visual recovery after MH repair.
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