Abstract
Purpose: :
To identify features of pre-operative spectral domain optical coherence tomography (SDOCT) scans that predict the long-term visual acuity (VA) improvement following macular hole (MH) surgery.
Methods: :
This is a retrospective, interventional, consecutive case series of eyes with idiopathic MH who underwent vitrectomy for MH repair. Inclusion criteria included preoperative SDOCT on the Cirrus HD-OCT (Carl Zeiss Meditec) and at least 12 month follow-up. All eyes underwent dilated ophthalmoscopic exam, SDOCT, and protocol ETDRS VA (converted to logMAR), preoperatively as well as at 6 and 12 months postoperatively. Correlation analysis was conducted between VA at baseline and one year with eight preoperative OCT parameters: manually measured MH nasal height, MH temporal height, MH minimum width, MH base width, total width of the inner segment (IS) outer segment (OS) defect, distance of IS/OS defect to temporal aspect of the MH, distance of IS/OS defect to nasal aspect of the MH and a novel automated computation of MH volume. MH volume was calculated using a custom algorithm for MH segmentation and volumetric calculation.
Results: :
Data from 23 eyes from 23 patients were included. All had successful closure of the macular hole. The preoperative VA and the length of the IS/OS defect on SDOCT preoperatively were the only statistically significant predictors for change in VA one year after surgical repair. MH volume was able to be successfully calculated on all eyes; however MH volume was not correlated with improvement in VA. None of the other manual OCT characteristics that were reviewed were correlated with improvement of VA at one year.
Conclusions: :
The preoperative length of the IS/OS defect was the strongest predictor for VA improvement one year after successful surgical repair. This suggests that despite the macular hole size the appearance of the IS/OS segments should be evaluated by SDOCT to predict the likelihood of visual recovery after MH repair.
Keywords: macular holes • vitreoretinal surgery