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Claudio Azzolini, Simona Maria Caprani, Simone Donati, Riccardo Vinciguerra, Claudia Bellina, Cesare Mariotti, Paolo Vinciguerra, Gianni Virgili, Bruno Lumbroso; Twelve months evaluation of idiopathic macular hole surgery: outer retinal layers recomposition and visual recovery.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1097.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate OCT retinal layers modification as determinants for functional recovery after vitreoretinal surgery for Idiopathic Macular Hole (IMH).
This prospective study included 21 eyes of 21 consecutive patients who underwent vitreoretinal surgery for IMH. We excluded patients affected by other different retinal diseases. According to the OCT evaluation of macular hole diameter, we divided patients in three groups (small IMH: 7 patients, medium IMH: 9 patients and large IMH: 5 patients). Baseline and follow up evaluations at month 1, 3, 6 and 12 included complete ophthalmological evaluation and instrumental examination. Morphological evaluation was performed by a deep analysis of retinal layers as well as mean central retinal thickness (CRT) with SD OCT (Topcon 3D OCT, USA). Functional evaluation was performed by ETDRS visual acuity and Amsler test. A standard 23G vitreoretinal surgery (Stellaris Vitrectomy Platform Bausch&Lomb, USA) was performed, posterior hyaloid and inner limiting membrane peeling by means of vital dyes completed by gas endotamponade. Statistical analysis was performed on collected data.
CRT significantly decreased from 361,54±120,36μm at baseline to 235,24±65,50μm at month 12 (p<0.05); a significant reabsorption of intraretinal edema and cysts was evident in 18 patients at month 12. Mean visual acuity significantly increased from 0,83 ± 0,25LogMAR at baseline to 0,21±0,12LogMAR at month 12 (p<0.05), fourteen patients reported a reduction in metamorphopsia, seven a reduction in the intensity of the central scotoma. Intraretinal layers modification showed a recomposition of IS/OS layer in 16 patients and a persistence of foveal hyporeflective area in the outer layers in 5 patients, corresponding to patients with a low VA recovery. We observed a progressive and dynamic recomposition of outer retinal layers in all patients during follow up from the immediate post operative control to the last 12 month visit.
SD-OCT examination shows the progressive recomposition of outer retinal layers after macular hole surgery. The visual function slowly follows this process by the reduction of metamorphopsia and the visual acuity increase. Negative prognostic factors are the presence of hyper reflective subretinal areas and intraretinal cysts.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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