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Julian Robins, Miles Parnell, Roger Wong; Progression of full thickness macular hole diameter in pre-operative patients: A retrospective analysis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5276. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Macular hole diameter is a strong prognostic indicator of macular hole repair success rates. Smaller opening diameter of the macular hole is known to confer a higher closure rate while smaller base diameter is associated with improved visual rehabilitation. Our aim is to investigate if significant change occurs in the diameter of macula holes from the period of listing for surgery to the time of closure surgery.
We performed a retrospective study of 25 patients who had undergone macular hole surgery and compared measurements of macular hole size at the time of listing for vitrectomy and on the day of planned surgery. Minimum limiting diameter (MLD) and Base diameter (BD) were recorded in microns(μm), using calliper measurements on Heidelberg OCT© software. Progression of change of diameter was measured both against time (T = r2-r1/t) and as a function of baseline diameter (R (% change) = r2-r1/r1) x 100). We divided the study population into two subgroups: small opening diameter (≤300 μm) and large opening diameter (>300 μm).
Mean follow up between OCT images was 100 days (range 60-199days). Mean Minimum limiting diameter at baseline was 305.4 (±30.9) microns, and base diameter 624 (±50.8) microns.Minimum limiting diameter: The overall mean rate of change 2.06(±0.64) μm/day for small holes (≤300 μm) and 1.2(±0.55) μm/day for large holes (>300 μm). This difference was not found to be statistically significant at p=0.13. The mean Relative rate of change (R) was 83.9% for smaller holes and 21.1% for large holes.Base diameter: Mean rate of change of base diameter was 2.93(±1.11)μm/day for small opening diameter holes and 2.27(±0.93)μm/day) for large opening diameter holes. Relative rate of change (R) was 51.9% increase over baseline for smaller diameter macular holes and 28.2% for large.
Pre-operative progression of macular hole opening and base diameter was demonstrated in all patients awaiting macular hole surgery. Smaller holes (<300 μm) increased at a faster rate both in terms of opening and base diameter, indicating that length of time between listing and surgery is more clinically relevant in this subgroup.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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