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Mark Alberti, Martin Nissen Hermann, Ulrik Correll Christensen, Morten la Cour; Progression of full-thickness macular holes prior to surgery. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2016.
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To measure full-thickness macular hole (FTMH) progression prior to vitrectomy and assess whether progression influences long-term visual outcome.
In this single-center, prospective pilot study, participants underwent serial preoperative optical coherence tomography (OCT) examinations to measure hole progression and a 36-month follow-up to assess long-term visual outcome. Primary outcomes were FTMH mean linear diameter (MLD) and postoperative ETDRS visual acuity. 3 masked examiners evaluated all OCT images to determine inter- and intra-observer variation. Progression was defined as size increase measured by all examiners.
37 participants (37 eyes) with a FTMH were included, 30 phakic and 7 pseudophakic. 5 patients were lost to follow-up and final long-term visual acuity was determined in 31 patients. Median preoperative progression was 77 µm (range: -235 µm to 351 µm), resulting in a change in classification for 45.9% FTMHs. Especially, small and medium holes increased in size; 54% of holes <400 µm progressed by 100 µm whereas no FTMH ≥ 400 µm progressed >100 µm (p = 0.002). Final analysis of 31 eyes showed a significant correlation between initial hole MLD and long-term BCVA (p = 0.03). We found no significant negative correlation between FTMH progression (MLD increase) and visual outcome (p = 0.56).
FTMH progression prior to surgery does not seem to negatively impact final visual acuity. This suggests that the initial damage upon hole creation is the major morphological determinant of final visual acuity. As hole size is dynamic, timing of baseline OCT-scanning is crucial to specify for meaningful FTMH classification.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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