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Manzo Taguchi, Sho Ishikawa, Tadashi Muraoka, Kouzo Harimoto, Tomohito Sato, Masaru Takeuchi; Length of preoperative ELM and IS/OS line defect correlate with postoperative visual acuity in patients with idiopathic macular hole. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2810.
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© ARVO (1962-2015); The Authors (2016-present)
The best corrected visual acuity (BVCA) and Gass classification for idiopathic macular hole (MH) are known to be predictive factors of BVCA after surgery. Spectral-domain OCT (SD-OCT) allows clear depiction of the inner segment/outer segment (IS/OS) line and the external limiting membrane (ELM), which have been used to describe the anatomic outcome of MH surgery. We investigated the correlation between the length of preoperative ELM or IS/OS line defect and postoperative BVCA in MH patients.
Eleven eyes with idiopathic MH in 11 consecutive patients (6 men and 5 women) who underwent 25G minimum incision vitrectomy in National Defense Medical College between January and October 2012 were enrolled in this study. The patients ranged in age from 63 to 86 years (mean 72.5 ± 6.2 years), and the stages in Gass classification were Stage I in 2, Stage II in 1, Stage III in 4, and Stage IV in 4. All patients underwent a combined procedure of phacoemulsification with placement of an intraocular lens, and internal limiting membrane (ILM) peeling using Brilliant Blue G was performed in all cases. Air was used for tamponade in all patients, and 20% sulfur hexafluoride gas was used in one patient during reoperation. At every ocular examination before and after surgery, BCVA was measured using the conventional decimal chart, and the lengths of ELM and IS/OS line defects were analyzed by SD-OCT (Heidelberg®).
BCVA converted to logMAR was 0.79 ± 0.22 before surgery and improved to 0.43 ± 0.32 at 1 month after surgery. The length of preoperative ELM and IS/OS line defect were 464 ± 341μm and 797 ± 298 μm, respectively, and were recovered completely in all patients within 3 months after surgery. The recovery periods were 11.9 ± 5.2 days for ELM and 33.9 ± 31.0 days for IS/OS line. Gass stage did not correlate significantly with pre- or postoperative BCVA, or with the length of preoperative ELM or IS/OS line defect. However, the length of ELM and IS/OS line defect before surgery correlated with BCVA at 1 month after surgery (ELM; p=0.0006, IS/OS line; p=0.0075).
This study suggests that the length of preoperative ELM and IS/OS line defect may be predictive factors of postoperative BCVA in patients with idiopathic MH.
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