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Simona Maria Caprani, Simone Donati, Marco Mazzola, Marianna Todarello, Arianna Ravasio, Marco Bianchi, Claudio Azzolini; Analysis of prognostic factors for a successful result after surgery for Idiopathic Macular Hole. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2797.
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© ARVO (1962-2015); The Authors (2016-present)
Surgery for Idiopathic Macular Hole (IMH) represents nowadays a recognized procedure in which the final results could be influenced by different not yet completely known factors. Aim of our study is to identify anatomical elements that could explain different outcomes, helping the surgeon on its complete evaluation of the patient.
We examined clinical data of twenty-five consecutive patients with a diagnosis of IMH who underwent surgery in our Ophthalmology Clinic, University of Insubria, Varese-Italy.At baseline, we evaluated functional and morphological parameters. Functional analysis includes BCVA, Amsler Test. Morphological data includes axial length in both eyes and measurement of characteristics of macular hole at OCT B-scans, by means of a manual calibre: maximum and minimum width, height of the hole, oblique diameters. All patients underwent standard 23-25G vitrectomy with ILM peeling with the use of Blue stain and gas SF6 Exchange. At the end patients maintained a face down posture for two days.Follow up data include visual acuity and morphological data about macular hole closure and progressive reconstitution of all outer retinal layers, at month 3, 6, 12.
At baseline we measured the following IMH mean values: maximum width 827±521mm, minimum width 386±258mm, macular hole height 416±130mm, oblique diameters 439±209mm and 433±189mm. Mean macular hole index was 0.75±0.59 and mean macula traction hole index was 1.2±0.51 and axial length was 25,44±2,65mm.Mean visual acuity increased from 0,55±0,27LogMAR to 0,48±0,12LogMAR at month 3 to 0,38±0,05LogMAR at month 6, to 0,32±0,21LogMAR at month 12. Our study showed a macular hole closure in 96% of eyes at month 3.A significative correlation between dimensional parameters and visual recovery was found, considering maximum and minimum mean diameters. Axial length could be evaluated as a risk of bias as it could represents a negative prognostic factors, considering that myopic macular hole represents a specific clinico-pathological category, also for performed surgical procedures.
Actual OCT instruments give us several anatomical details to evaluate preoperative and healing process in macular hole. A correct and deep analysis of OCT characteristics could suggest the behaviour of macular hole after surgery and the functional recovery to be predicted to patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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