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Sumeer Thinda, Rohan Shah, Stephen Kim; One-year anatomical and functional outcomes after macular hole surgery: a prospective controlled study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5770.
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To determine 1-year anatomical and functional outcomes of eyes undergoing full thickness macular hole (FTMH) surgery with vitrectomy, indocyanine green (ICG) staining, and removal of internal limiting membrane (ILM).
Ten patients undergoing unilateral FTMH surgery were analyzed. Both the surgical eye (SE) and fellow eye (FE) were examined preoperatively, at 3 months postoperatively, and at 12 months. Best corrected visual acuity (BCVA), intraocular pressure, central corneal thickness, gonioscopy, Humphrey visual field (HVF), fundus photography and autofluorescence and spectral domain optical coherence tomography (SD-OCT) of the macula and optic nerve were recorded at each visit. HVFs were analyzed for location of visual field defects, mean deviation (MD) and pattern standard deviation (PSD). SD-OCT images were analyzed for changes in the retinal nerve fiber layer (RNFL), external limiting membrane (ELM), inner segment/outer segment (IS/OS), cone outer segment tips (COST) and ganglion cell-inner plexiform layer thickness (GCIPL). Statistical analysis was performed using the paired student t-test, one way ANOVA, linear regression and Spearman’s correlation coefficient.
There was significant improvement in BCVA of SE at 3 months (p=0.0001) and 12 months (p=0.0002) when compared to baseline. MD was lower in SE (-2.83 ± 2.29) compared to FE (-1.67 ± 1.28) and approached statistical significance at 12 months (p=0.07). At 12 months, SE had significantly higher PSD (3.50 ± 2.42) compared to FE (2.05 ± 0.64; p=0.04) and baseline (2.31 ± 0.83; p<0.05). At 12 months, SE had significantly thinner RNFL inferiorly (110 ± 12.2) compared to FE (123 ± 9.82; p<0.05) and baseline (120 ± 8.05; p=0.02). Size of defect in ELM, IS/OS junction and COST line were significantly correlated with BCVA (r=0.64, p=0.0001; r=0.6961, p<0.0001; r=0.7324, p<0.0001; respectively). Both average GCIPL and individual GCIPL sectors (superior, superonasal, inferonasal, inferior, inferotemporal and superotemporal) were all significantly thinner in SE compared to FE at 3 (p<0.05) and 12 months (p<0.04).
Eyes that underwent FTMH repair with use of ICG and removal of ILM demonstrated significantly increased PSD and inferior RNFL thinning. Degree of persisting defects in ELM, IS/OS junction and COST line predicted visual recovery and GCIPL was significantly thinner in SE at 3 and 12 months after surgery.
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