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Julia Sabina Klein, Sabrina Bohnacker, M. Ali Nasseri, Nikolaus Feucht, Chris Lohmann, Mathias M Maier; Correlation of Intraoperative Morphology and Postoperative Outcome in Patients with Full Thickness Macular Hole (FTMH). Invest. Ophthalmol. Vis. Sci. 2017;58(8):2792.
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© ARVO (1962-2015); The Authors (2016-present)
Due to intraoperative Optical Coherence Tomography (iOCT), a new technology, precise changes in microstructure caused by surgical manipulation can be evaluated.In this retrospective, observational clinical study we examined the impact of the intra operative retinal morphology on the postoperative outcome in patients with FTMH.
22 consecutive eyes of 22 patients with FTMH (77% female, 23% male, average age 69.8 years) without retinal pre-treatment have been investigated. Surgery was performed using the OPMI Lumera 700 OP-microscope with integrated iOCT Rescan 700 (Carl Zeiss Meditec AG).Prior to, during and on average 9 weeks after surgery OCT examination has been performed. The aperture of each FTMH and the Macular Hole Index (MHI = relation of hole height and base diameter) during the surgery were measured via ImageJ.Postoperative closure of the FTMH, integrity of the retinal layers and visual acuity (VA) were assessed.
The aperture of the FTMH appeared smaller after every surgical activity. The average downsizing after vitrectomy was 36,2 µm (SD=105,5 µm; p=0,22), after membrane peeling 64,8 µm (SD=124,7; p=0,07) and after tamponade 11,8 µm (SD=192,8 µm; p=0,91). There was no significant correlation between MHI and visual outcome. FTMH was closed in all examined eyes by the time of the first follow-up examination (9 weeks on average). External limiting membrane (ELM) was intact in 63,6%, Outer segments (OS) in 18,2%, ellipsoid zone in 13,6%. VA was significantly better even by the time of the first follow-up examination (p=0,01). The average VA preoperatively was 0,62 logMAR (SD=0,24), 0,47 logMAR (SD=0,24) at first follow-up examination and 0,24 logMAR (SD=0,15) after 6 months or more.
The results show a downsizing of the FTMH during surgery. There was no significant correlation between MHI during surgery and postoperative VA. The ELM appears to be the first retinal layer to recover after FTMH surgery. OS and ellipsoid zone were not faultless by the time of 12 weeks in most of the observed cases.However, a bigger number of cases is needed to make an overall prognosis on postoperative morphology and function.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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