Relationship Between Pre-Operative Macular Hole Morphometry Assessed on Spectral Domain OCT Images With Functional and Anatomical Outcomes

Abstract

 

Purpose:

 

To assess the relationship between pre-operative idiopathic macular hole (MH) morphology as assessed by Spectral-Domain OCT (SD-OCT) with anatomical and functional outcomes.

 

Methods:

 

Prospective interventional case series included 31 eyes of 31 patients with MH stage 2 to 4. Best Logmar visual acuity (VA), fundus biomicroscopy, lens opacity grading were performed preoperatively and at last follow-up visit (at least 6 months after surgery). Included patients were pseudophakic or with clear lens before and at final VA measurement. SD OCT cross hair scan was obtained three times by the same operator, and the scan with higher MH diameter was selected for analysis. Height (H), External Base (EB) and Internal Base (IB) measurements using OCT caliper tool were used to calculate the Macular Hole Index (MHI), Prognostic Macular Hole Index (PMHI), and a new macular hole index (NMHI). MHI formula considered H/ EB, PMHI used H/IB and NMHI considered H+(EB-IB)/IB. Vitrectomy with internal limiting membrane peeling and gas tamponade was performed by one experienced surgeon. Patients were classified in three groups according to VA variation.

 

Results:

 

Five eyes (16.13%) did not attain MH closure after surgery. NMHI measurements demonstrated good intra-observer reproducibility (RC=0.66, ICC=9.983). VA variation was significantly associated with MHI and NMHI (p=0.04 for both cases). Table 1 presents MH indexes mean values according to VA variation after surgery. The anatomical outcome (MH closure) was significantly associated with all MH indexes (MHI [p=0.03], PMHI [p=0.03], NHMI [p=0.05].)

 

Conclusions:

 

In this small sample, MHI and NMHI were significantly correlated with VA outcome. All MH indexes were significantly correlated to final anatomic outcome. Higher indexes are related to better functional and anatomical outcomes.  

 

Keywords: macular holes • vitreoretinal surgery • macula/fovea