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C. P. Graeber, A. N. Athanikar, J. N. Cohen, K. J. Wald; Pre-Operative Size Does Not Predict Post-Operative Morphology of Macular Holes. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1338.
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While studies have correlated pre-operative macular hole size (POMHS) with post-operative visual outcomes, and post-operative morphology (POM) has been described, no study has correlated POM with POMHS measured with optical coherence tomography (OCT).
The pre-operative and post-operative OCTs for 155 consecutive patients who underwent successful macular hole surgery were reviewed. The post-operative OCT was performed 3 to 9 months after surgery. The hole’s pre-operative base and mid-hole size were measured and placed into three categories: 1000µ. The POM of the repaired hole based on horizontal section of the OCT was categorized as: 1) normal foveal architecture, 2) "flat" foveal umbo, 3) "U" pattern, and 4) "V" pattern. Normal foveal architecture was defined as a return to normal retinal thickness and contour. The flat pattern was defined as an everted or flat foveal depression. U pattern was defined as a thin layer of retina at the base with a rounded contour. V was defined as focal retinal thinning centrally. In addition, the presence of persistent subretinal fluid beneath the fovea was noted. The groups of patients were compared to determine if POMHS correlated with POM morphology using Chi-squared analysis.
Of the 155 patients with macular holes, 112 met the inclusion criteria. POM findings included 37 (33%) normal foveal architecture, 20 (18%) flat, 39 (35%) U shaped , and 16 (14%) V shaped. 19 (17%) of them had persistent subretinal fluid between 3 and 9 months. Neither the base nor the mid-hole pre-operative size correlated with POM (P>0.05). Pre-operative mid hole size was related to the presence of subretinal fluid (P=0.02), although base hole size was not (P=0.54). 500-1000µ holes were negatively correlated with subretinal fluid (P=0.037), while >1000µ were positively correlated with persistent fluid (P=0.019). Less than 500µ had no significant relationship with subretinal fluid (P=0.195).
POMHS has been reported to correlate with anatomic success. The POM has also been reported to relate to visual outcome. This is the first study to evaluate POM as related POMHS. Surprisingly, there does not appear to be a correlation. The only significant anatomic outcome is the correlation of subretinal fluid with mid-hole size >1000µ. Measurement of the mid-hole size may prove to be a clinically useful parameter for post-operative outcomes. Further study of patients with persistent subfoveal fluid will determine the clinical relevance of this finding.
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