Foveal Detachment after Idiopathic Macular Hole Treatment

Abstract

 

Purpose

 

To analyze the foveal microstructure of eyes treated for idiopathic macular hole (MH) and to identify clinical and anatomical risk factors of post treatment foveal detachment (FD).

 

Methods

 

A retrospective analysis was performed on 105 eyes from 105 consecutive patients treated for MH. This included 100 eyes treated by vitrectomy and gas tamponade and 5 eyes treated by a single intravitreal injection of ocriplasmin. The anatomical features of FD detected on postoperative spectral-domain optical coherence tomography (SD-OCT) were analyzed and correlated with morphological and clinical data at baseline, 1 month and 3 months after treatment. The size of defect was measured and compared with pre-treatment MH base diameter.

 

Results

 

In the 100 eyes treated surgically, FD were noted on postoperative SD-OCT in 18% of eyes (12/65 eyes) and 4% (3/70 eyes) at 1 months and 3 months after surgery respectively. The base diameter of the defect at 1 month (371±92 μm) and 3 months (341±104 μm) postoperatively was always smaller than the preoperative MH base diameter (766±203 μm). Conversely, in the eyes treated by ocriplasmin, FD was noted in all eyes and the base diameter of the defect at 1 month (1375± 842 μm) and 3 months (903±833 μm) after the injection was always larger than the preoperative MH base diameter (544±61 μm). FD did not significantly alter visual recovery in closed MH surgically. FD did not statistically decrease the visual acuity in eyes treated with ocriplasmin (from 0.7 to 0.68 Logmar before and 1 month after the injection respectively).

 

Conclusions

 

This is the first SD-OCT study of foveal anatomy in FD after MH surgical and non-surgical treatment. The base diameter of FD was always smaller than the preoperative MH base diameter after vitrectomy. Conversely, the base diameter of FD was always larger after intravitreal ocriplasmin suggesting a specific effect of this enzyme.  

 

Figure: A and B. SD-OCT of a macular hole (MH) treated surgically. A. The MH preoperative base diameter was measured at 478 μm. B. The postoperative SD-OCT showed a foveal detachment with a base diameter of 256 μm, 1 month after surgery. C and D. SD-OCT of a MH treated with an intravitreal injection of ocriplasmin. C. The initial base diameter of the MH was measured at 501 μm. D. A foveal detachment was detected on SD-OCT 1 month after the injection and the base diameter of the defect was measured at 2202 μm.