Three-Dimensional Macular Hole Segmentation and Trans-tamponade OCT Findings in the DISCOVER Study: Implications for Postoperative Positioning

Abstract

Purpose : Extended face-down positioning in postoperative management of full-thickness macular hole (FTMH) surgery remains controversial. The goal of this study was to evaluate both trans-tamponade OCT and preoperative volumetric FTMH features for opportunities for precision positioning following surgery.

Methods : This study was a post hoc analysis of eyes that underwent FTMH repair in the prospective DISCOVER iOCT study. Inclusion criteria required preoperative OCT and postoperative day 1 (POD1) trans-tamponade imaging of sufficient quality to determine hole closure. All eyes underwent small-gauge vitrectomy with internal limiting membrane peeling. Preoperative OCTs were analyzed with a machine learning enhanced feature extraction platform that enabled volumetric segmentation of the FTMH. Trans-tamponade OCTs were reviewed for hole closure and preoperative geometric segmentation features were compared based on closure status on POD1. Ten parameters were analyzed including maximum foveal height, apex area, base area, central foveal area, maximum apex diameter, maximum base diameter, maximum depth, minimum foveal width, volume, and en face area.

Results : A total of 66 eyes were included. Nine eyes (14%) had open macular holes on POD1 trans-tamponade OCT, and the remaining 57 (86%) were closed. Out of the 9 open FTMH, seven (78%) were repairs on eyes that were chronic and/or re-operated MH’s while 2 eyes (12%) were not. Of the 57 eyes with closed POD1 MH, eleven (19%) were chronic and/or re-operated compared to 46 eyes (81%) that were not. Eyes with open POD1 MH were 13.8 times more likely to have been chronic and/or re-operated (p=0.01). All open FTMH on POD1 were closed by postoperative month 1. Comparison of three-dimensional FTMH features between closed and open FTMH on POD1 trans-tamponade OCT are shown in Table 1. Nine of the ten variables were found to be significantly different between groups (all p values <0.02).

Conclusions : This study suggests that three-dimensional FTMH measurements are potentially important predictors for MH closure speed. Precision positioning time in MH surgery could help preserve the exceptional closure success, lower perioperative morbidity, and enhance quality of life. Future multi-center clinical trials are being planned.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Table 1. Three dimensional FTMH analysis comparing closed and open MH on POD1 trans-tamponade OCT.