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Jiro Kogo, Akira Shiono, Hitoshi Takagi, Satoki Ueno; Early Postoperative Length of External Limiting Membrane Defect is Prognostic Factor of Visual Outcome in Macular hole Surgery. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2149.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate morphological prognostic factors for postoperative visual outcome in macular hole (MH) surgery.
Thirty four patients (thirty four eyes) who had underwent successful vitrectomy for idiopathic macular hole and followed up for at least 6 months were included. Best-corrected visual acuity (BCVA) and fovea images using spectral-domain optical coherence tomography (SD-OCT) were examined at 1, 3, and 6 months (1M, 3M and 6M) postoperatively. We assessed length of external limiting membrane (ELM) defect, length of photoreceptor inner/outer segment junction (IS/OS) defect and cone outer segment tip line (COST-line). Appearance of the COST-line was graded from 0 to 2: Grade0, COST-line not visible; Grade 1, abnormal COST-line; and Grade 2, normal COST-line. Multiple regression analysis using 1M postoperative morphologic factors was performed to identify factors significantly associated with BCVA at 6M.
Length of IS/OS defect were 1M; 355±377µm, 3M; 116±158µm, 6M; 25±52µm. The IS/OS defect at 6M correlated with BCVA (1M; p=0.15, 3M; p=0.75, 6M; p=0.001). Length of ELM defect were 1M; 125±216µm, 3M; 24±89µm, 6M; 21±67µm. The ELM defect were correlated with BCVA at all examined time points (1M; p=0.0007, 3M; p=0.003, 6M; p=0.014). Status of COST-line at 1M were Grade 0; 100%, Grade 1; 0%, and Grade2; 0%, respectively. Those of 3M were Grade 0; 62%, Grade 1; 38%, and Grade2; 0%, respectively. These of 6M were Grade 0; 57%, Grade 1; 24%, and Grade2; 19%, respectively. And the integrity of COST-line at 6M was correlated with BCVA (p=0.024). Multiple regression analysis showed that the length of ELM at 1M yielded the highest correlation coefficient with BCVA (p=0.038).
These results suggest that early postoperative length of ELM defect is prognostic factor of visual outcome.
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