Abstract
Purpose :
To describe the sequential morphological changes following a full-thickness macular hole (FTMH), utilizing a novel, objective staging system based on spectral domain optical coherence tomography (SD-OCT), and to determine its association with baseline visual acuity (VA) and duration of symptoms.
Methods :
Patients were recruited from St.Michael’s Hospital, Toronto Canada, and Retina Consultants of Texas, Texas, Houston, USA, from 2009 to 2022 .Multimodal imaging of 1000 patients diagnosed with primary FTMH were retrospectively examined. To be included in the study patients had to have at least two preoperative SD-OCT scans and no previous vitrectomy or other retinal pathology . The staging was based on the assessment of outer retinal morphology on successive SD-OCT foveal scans.
Results :
52 eyes were included. The mean age (SD) was 65.4 (8.4) years. 67.3% (35/52) were female. The mean presenting logMAR(SD) VA was 1.03 (0.41).The mean time between two preoperative OCTs was 241.86 +/-343 days. Outer retinal changes following macular hole occurred in 4 stages: 1) separation of the neurosensory retina from the RPE with well-defined interdigitation zone (IDZ), ellipsoid zone (EZ), and external limiting membrane (ELM) (4/52,7.6%); 2) Hydration: thickening of photoreceptor inner (IS) and outer segments (OS) (27 /52;51.9 %) ; 3) patchy (moth-eaten)photoreceptor loss (16/50;30.7%); 4) severe or complete loss of ISs and OSs and /or bare ELM (5/52, 9.6%).
In the follow-up preoperative OCT assessed, none of the stage 1 macular holes remained at the same stage. 28.85 % (15 /52) of eyes were in stage 2; 34.62 % (18 /52) in stage 3 and 36.54% (19 /52) were in stage 4.
The progression time in days (SD) from Stage 1 to Stage 2 was 21(0), Stage 2 to Stage 3 was 284 (216.7), and Stage 3 to 4,was 482(543.4). There was a statistically significant association between increasing stage and longer duration of macular hole symptoms (p=0.032) and, most importantly, between increasing stage and worse VA at baseline (p<0.001), β= 0.22 (95%CI = 0.11-0.33) after adjusting for age, sex, and lens status.
Conclusions :
This novel staging system describes the sequential morphologic changes in FTMH with SD-OCT over time. The baseline morphological stage of FTMH was associated with the duration of symptoms and baseline visual acuity. This objective staging system provides a potential novel imaging biomarker for FTMH
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.