Abstract
Purpose: :
To evaluate morphological prognostic factors for postoperative visual outcome in macular hole (MH) surgery.
Methods: :
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.
Results: :
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).
Conclusions: :
These results suggest that early postoperative length of ELM defect is prognostic factor of visual outcome.
Keywords: macular holes • photoreceptors • retina