Quantitative analysis of photoreceptor loss in full-thickness macular hole: a promising predictor of postoperative functional and anatomical results

Abstract

Purpose : To describe a novel quantitative index of photoreceptor loss in full-thickness macular hole.

Methods : Thirty-seven eyes from 37 patients affected by idiopathic full-thickness macular holes were included in this study. Eyes were analyzed preoperatively and followed up for 6 months after surgery. Best-corrected visual acuity (BCVA) and cross-sectional images of macular holes using B-scan optical coherence tomography (OCT) and en-face OCT were recorded. Quantitative changes in ellipsoid zone (EZ) and external limiting membrane (ELM) integrity were assessed and correlated with postoperative anatomical and functional recovery. The photoreceptor Integrity index (PIIN) was calculated and correlated with the minimum diameter of the hole, base diameter of the hole, the postoperative BCVA, pre and postoperative EZ and ELM defects.

Results : Higher PIIN correlated with higher BCVA at six months (P<0.001). Multiple regression analysis showed that the PIIN had a more significant correlation with the postoperative visual acuity than any other variable evaluated (P=0.008), with good predictability (R=0.433±385). ROC curve obtained for the PIIN as a predictor of a good visual prognosis showed sensitivity and specificity of 93.3% and 52.4% for the cut-off value 0.375.

Conclusions : The PIIN is a promising tool to evaluate photoreceptor loss in macular hole and to estimate postoperative functional and anatomical recovery.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Cartoonized representation of the macular hole from a bird-eye view and comparison with en-face OCT. The scan shows densely packed photoreceptors at the border of the hole, with disrupted ones that fall off the border and lie over the retinal pigmented epithelium as remnants.

 

Receiver Operating Curve (ROC) obtained for photoreceptor integrity index (PIIN), with an area under the curve of 0.760, representing good reliability of the index in predicting post operative best corrected visual acuity.