Abstract
Purpose: :
To investigate patterns of Fundus Autofluorescence (FAF) before and after macular hole surgery with internal limiting membrane peeling. To correlate these findings to the intraoperative use of Indocyanine Green (ICG) and Kenalog, duration of a full thickness macular hole (FTMH), as well as visual acuity (Va) outcomes.
Methods: :
All patients included in the study have had MH surgery (01/2000-12/2006). Preoperative Va, postoperative Va, stage and duration of MH, use of intraoperative ICG/Kenalog were recorded. FAF, color fundus photographs and OCT (Carl Zeiss Meditec) images were reviewed pre and post operatively.
Results: :
15 eyes of 13 subjects were included in the study. 4 have undergone ICG assisted membrane peeling, 2 Kenalog assisted membrane peeling, and 9 had MH surgery without ICG or Kenalog. Average preoperative Va (reported in Snellen and logMAR) was 20/560 (-0.93) for ICG group, 20/200 (-1.00) for Kenalog group and 20/320 (-0.83) for non-ICG/Kenalog group. Average postoperative Va was 20/133 (-0.57) for ICG group, 20/135 (-0.78) for Kenalog group and 20/30 (-0.21) for non-ICG/Kenalog group. Average duration of macular hole prior to surgery was 9 weeks (range 4-20wks) for ICG group; 50 week (range 44-56) in Kenalog group; and 7 week (range 2-32) for non-ICG group.All macular holes had a successful anatomic outcome with complete closure (by OCT).FAF for ICG group was abnormal in 3/4 eyes. FAF was abnormal in both eyes in Kenalog group. FAF in non-ICG/Kenalog group was abnormal in 3/10 eyes. Hyper/hypo AF lesions were seen either scattered throughout the posterior pole or localized in some of the eyes of all three groups.5 eyes with the worst Va outcome (20/60, 20/70, 20/80, 20/200, 20/400) all had significant changes in posterior pole on FAF (all 3 groups were represented). There was a trend of increased FAF changes with longer preoperative duration of MH (>20wks).2 eyes had preoperative FAF and both had distinctive "bulls-eye" (hyper-hypo-hyper pattern). Postoperatively, normal FAF was noted in these eyes.
Conclusions: :
FTMH have a distinctive FAF pattern in the fovea preoperatively. FAF is a good adjunctive tool to OCT in confirming MH closure. ICG group and Kenalog group had more abnormal FAF throughout posterior pole than non-ICG/Kenalog group. Nevertheless, no particular pattern of FAF was identified. Worse Va seemed to correlated with most changes in posterior pole, as well as duration of macular hole. Larger number of subjects need to be studied with pre and post operative FAF in order to make further conclusions.
Keywords: macular holes • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)