Abstract
Purpose :
Vitreo-macular traction is thought to play a role in the pathogenesis of idiopathic macular hole. The objective of this observational clinical study was to examine whether surgical removal of the posterior hyaloid via vitrectomy for macular hole alters macular contour.
Methods :
Macular shape was taken from the retinal pigment epithelial contour imaged with radially oriented spectral domain optical coherence tomography scans centred on the fovea. There were 12 B scans per exam, each 6 mm wide, with adjacent scans separated by 15°. Images were taken at time of diagnosis of macular hole, then after vitrectomy and dissipation of intraocular gas. The pre-operative and post-operative macular shape for each eye was compared using the average and range of best fit curvature (K), and the average and range of the difference between the best fit curvature and actual retinal shape in the 12 scans (the “irregularity”). A consecutive series of eyes that were imaged before then after spontaneous posterior vitreous detachment (PVD) were analysed the same way. Significance was determined by paired t-test (for comparison before and after surgery or PVD) or two-sample t-test for secondary outcomes (effects of gender on shape; shape on surgical success; comparison of eyes with and without a macular hole).
Results :
Of 52 participants with a macular hole, 17 were male and 35 female, with a mean (standard deviation) age 69.2 (8.0) years and mean axial length 23.84 (1.63) mm. Four holes failed to close after a single procedure. Mean macular curvature fell significantly from before (Kpre = 0.027 (0.016) mm-1) to after surgery (Kpost = 0.025 (0.015) mm-1, p = 0.01). There were no significant differences in within-eye range of curvature or mean or range of irregularity between the pre- and post-operative states, and no significant differences in shape by gender, or when comparing successful to unsuccessful surgery.
No significant shape change was seen in the 28 eyes imaged before then after spontaneous PVD (KnoPVD = 0.022 (0.016) mm-1, KPVD = 0.021 (0.017) mm-1, p = 0.67). There was no significant difference between the pre-operative curvature of macular hole eyes and those eyes imaged prior to PVD (p = 0.10).
Conclusions :
Surgery for macular hole produces a small but statistically significant reduction in macular curvature, that is not seen in eyes undergoing spontaneous PVD.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.