Foveal Microstructure and Visual Acuity in Surgically Closed Macular Holes: Spectral-Domain Optical Coherence Tomographic Analysis

doi:10.1016/j.ophtha.2010.01.017

Ophthalmology

Volume 117, Issue 9, September 2010, Pages 1815-1824

Presented in part at: the American Academy of Ophthalmology annual meeting, November 2008, Atlanta, Georgia.

https://doi.org/10.1016/j.ophtha.2010.01.017 Get rights and content

Purpose

To evaluate reconstructive changes in foveal microstructures and identify a correlation with visual outcomes in eyes with surgically closed macular holes (MHs).

Design

Retrospective, consecutive, observational case series.

Participants

Forty eyes (40 patients) with surgically closed MHs.

Methods

Spectral-domain optical coherence tomography (SD-OCT) was performed to assess the foveal microstructural changes 3 and 12 months postoperatively. The correlation between the postoperative best-corrected visual acuity (BCVA) and the integrity of the foveal photoreceptor layer was evaluated.

Main Outcome Measures

The integrity of the back-reflection lines from the photoreceptor inner segment (IS) and outer segment (OS) junction and the external limiting membrane (ELM) on SD-OCT images and the BCVA measured on the same day.

Results

The integrity of the foveal photoreceptor layer was the only postoperative SD-OCT finding significantly associated with the 3-month BCVA (r=0.483; P=0.002). The eyes were categorized into 3 groups according to restoration of the IS/OS junction and ELM signals: 6 eyes (15%) in group A with complete restoration of the IS/OS junction and the ELM; 26 eyes (65%) in group B with a disrupted IS/OS junction and intact ELM; and 8 eyes (20%) in group C with disruption or loss of the IS/OS junction and the ELM. Although the baseline BCVA did not differ significantly (P=0.137) among groups, the mean 3-month BCVA values in groups A and B, both with reconstructed ELM with or without a restored photoreceptor IS/OS, were significantly better than in group C (P<0.05); the difference between groups A and B was not significant (P>0.05). Groups A (P=0.029) and B (P<0.001) had significant visual improvement at 12 months; group C did not have marked visual recovery. Fourteen eyes (54%) in group B had subsequent realignment of the foveal photoreceptor IS/OS; no eyes in group C had a restored IS/OS at 12 months. The presence of the ELM at 3 months is a critical structural feature significantly correlated with the BCVA at 12 months (r=0.832, P<0.001).

Conclusions

Reconstruction of the foveal ELM in the early postoperative period helps predict subsequent restoration of the foveal photoreceptor layer and the potential for better visual outcomes.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

A consecutive series of patients who had undergone anatomically successful MH closure at Osaka University Hospital between September 2006 and June 2008 and were followed for at least 12 months postoperatively were enrolled in this observational study. All patients were diagnosed with a stage 2, 3, or 4 idiopathic MH according to the Gass classification system¹⁷ and underwent a comprehensive ophthalmologic examination before and 1, 3, and 12 months postoperatively, including measurement of the

Results

Fifty eyes of 50 consecutive patients with surgically closed MHs and a postoperative follow-up period of at least 12 months were enrolled initially. Ten eyes were excluded because 6 eyes had MHs secondary to high myopia and 4 eyes had diabetes mellitus possibly affecting the central vision. Therefore, 40 eyes of 40 patients (12 men, 28 women) met the study criteria for subsequent data analysis.

The preoperative baseline characteristics of the 40 eyes are summarized in Table 1. The mean patient

Discussion

High resolution of the retinal microstructural features with SD-OCT recently led several investigators to correlate the integrity of the foveal photoreceptor layer with the visual outcomes after successful MH repair. However, the results in previous studies varied.13, 14, 15, 16 Although restoration of the photoreceptor layer has been proposed as an important feature associated with visual outcomes in previous OCT imaging studies, specific structural characteristics used to determine the

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To investigate the time courses of morphologic changes in the transplanted grafts, including the retinal layer, the ellipsoid zone (EZ) and the visual acuity (VA) after autologous retinal transplantation (ART) in patients with primary large macular holes (MHs).
Single-center, retrospective cohort study.
The study included 17 eyes of 17 patients who had undergone ART. All patients fulfilled the following criteria: (1) MH was the only disease-causing anatomic abnormality of the macula; (2) they could be followed up for at least 12 months after ART surgery; (3) they had no other systemic disorders; and (4) the MH was > 400 μm in diameter.
Data of all patients who underwent assessment of the VA and spectral-domain (SD)-OCT at 1, 3, 6, and 12 months after surgery were analyzed. The morphologic features of the graft and the EZ were measured by SD-OCT.
Changes in the morphologic features of the graft (graft thickness, overall graft area, graft length, area of outer retina, and EZ) and VA over 1 year after surgery.
Closure of the MH was achieved in all patients. The VA was 0.59 ± 0.27 (logarithm of the minimal angle of resolution units) at 1-year postsurgery compared with 0.84 ± 0.22 before surgery (P < 0.05). The retinal layers gradually became smoothly connected. Although a decrease in graft thickness and overall graft area was observed, the length and area of the outer retina were maintained throughout the follow-up period. The presence of the EZ was observed in 9 patients (52.9%) and our analyses revealed significantly greater improvement of VA in these patients than in those without the EZ (P < 0.05). Moreover, the incidence of macular edema (ME) was higher in the group without the EZ (P = 0.04; chi-square test).
Patients showed significant improvements of the VA. Morphologically, the layers were gradually connected to each other, and the outer retina was particularly maintained. Especially, patients in whom an EZ was restored in the graft showed a low prevalence of ME and greater improvement of the VA.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
En Face OCT Detects Preretinal Abnormal Tissues Before and After Internal Limiting Membrane Peeling in Eyes with Macular Hole
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To assess preretinal abnormal tissue (PAT) using en face OCT in eyes with idiopathic macular holes (MHs).
Retrospective, observational study.
Patients with MH who received 6 × 6-mm spectral-domain-OCT scans.
Preretinal abnormal tissue was detected by en face OCT images with a custom slab, defined with an anterior boundary of 6 μm anterior to the internal limiting membrane (ILM) and a posterior boundary at 3 μm posterior to the ILM. The PAT was defined as any abnormal tissues observed in en face OCT.
Characteristics of preoperative and postoperative PAT.
Sixty eyes with MH from 60 patients were included. Fifty-one eyes underwent preoperative analysis, and 46 eyes underwent postoperative examination. Before surgery, 48 (94%) eyes had a mean (standard deviation [SD]) PAT of 6.6 (9.8) mm². The corresponding cross-sectional OCT showed PAT consisting of epiretinal proliferation, epivascular glia, and a preretinal hyperreflective band. Preretinal abnormal tissue was contiguous to the hole (peri-MH PAT) in 12 eyes (24%), whereas others (36 eyes, 76%) had a scattered distribution (extrafoveal PAT). The area of PAT was greater in eyes with a peri-MH PAT than in eyes with an extrafoveal PAT (P < 0.0001). Compared to the eyes with the extrafoveal PAT, the eyes with the peri-MH PAT were associated with men (P = 0.0059) and worse baseline visual acuity (VA) (P = 0.0002). In eyes with ILM peeling (42 eyes), postoperative PAT proliferation was observed from the edge of the ILM peeling toward the periphery over a 1-year follow-up. The mean (SD) area of PAT at 2 weeks after surgery was 3.4 (3.6) mm² and increased to 12.1 (6.4) mm² at 12 months (P < 0.0001). However, no PAT increase was observed in 4 eyes that underwent vitrectomy without ILM peeling. The postoperative PAT size was not associated with the postoperative VA.
En face OCT revealed PAT in most eyes with MHs. Peri-MH PAT was associated with worse VA and was seen more frequently in male patients. Postoperative PAT proliferation may be triggered by ILM peeling, but it is not associated with worse VA.
Association of macular hole intraretinal fluid and visual acuity
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This study investigates the association between preoperative intraretinal fluid (IRF) area and preoperative and postoperative best-corrected visual acuity (BCVA) in surgically repaired idiopathic macular holes (MH). This study further evaluates other prognostic indices related to MH repair that may assist clinicians’ understanding of MH operative management.
Retrospective cohort study conducted at a single institution.
A total of 251 patients who underwent surgery for idiopathic MH between January 2012 and January 2021.
Segmentation was performed on ocular coherence tomography scans of 251 eyes with MH and IRF. Associations between IRF area and preoperative and postoperative BCVA at 1, 3, and 6 months, preoperative and postoperative central subfield thickness, MH diameter, staging, closure status, and type of closure were evaluated using Spearman's correlation analysis.
Preoperative IRF area was moderately correlated with preoperative BCVA (r = –0.32; p < 0.001) and negligibly correlated with postoperative BCVA at 1, 3, and 6 months (r = –0.14, p = 0.026; r = –0.21, p < 0.001; and r = –0.19, p < 0.001, respectively). Preoperative IRF area was strongly correlated with MH minimum linear diameter (r = 0.56; p < 0.001) and MH base diameter (r = 0.65; p < 0.001). Other associations were not statistically significant.
Preoperative IRF area in patients with idiopathic MH demonstrated a moderate correlation with preoperative BCVA and a negligible or weak correlation with postoperative BCVA at up to 6 months, suggesting that vision may not have a clinically significant relationship with IRF in the setting of MH.
Clinical Characteristics of Macular Hole and Macular Epiretinal Membrane in Dominant and Nondominant Eyes
2023, Biomedical and Environmental Sciences
Modified superior inverted internal limiting membrane flap technique with vitrectomy versus vitrectomy with internal limiting membrane peeling for retinal detachment with myopic macular hole
2022, Archivos de la Sociedad Espanola de Oftalmologia
Evaluar la eficacia de la técnica del flap invertido superior de membrana limitante interna (MLI) modificada para el tratamiento del desprendimiento de retina (DR) por agujero macular (AM), comparada con el pelado clásico de la MLI.
Análisis retrospectivo de 10 pacientes que requirieron vitrectomía pars plana por DR con AM. Se dividieron en dos grupos, según la técnica quirúrgica realizada: grupo del flap (5 pacientes) y de pelado de MLI (5 pacientes). Se comparó la agudeza visual mejor corregida (AVMC) pre y posquirúrgica, la resolución del DR, la tasa de cierre del AM y la restauración de las capas externas de la retina entre los grupos.
La AVMC poscirugía mejoró en ambos grupos, sin diferencias significativas (p = 0,9). La tasa de cierre del AM fue del 100% en el grupo del flap y del 80% del grupo de pelado de la MLI, sin diferencias significativas entre los grupos. La retina se reaplicó en el 100% de los casos en ambos grupos. Solo se restauraron las capas externas de la retina en 2 pacientes del grupo del flap invertido (40%) y en ninguno del grupo de pelado de la MLI (p = 0,62).
Las técnicas de pelado de MLI y del flap invertido superior modificada son útiles para el tratamiento del DR con agujero macular en ojos miopes.
To evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling.
Retrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups.
There were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (P = .9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (P = .62).
ILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.
Management of refractory and recurrent macular holes: A comprehensive review
2022, Survey of Ophthalmology
The primary repair of full-thickness macular holes (FTMHs) through pars plana vitrectomy with internal limiting membrane peeling and gas tamponade is the current standard of practice and offers a high closure rate of approximately 90%. On the contrary, the surgical management of refractory (or persistent) and recurrent FTMHs is still a challenging and controversial topic in vitreoretinal surgery as multiple options have been suggested, particularly over the last few years, with no consensus regarding any appropriate selection criteria or the best surgical option. Moreover, the presence of various case series / interventional studies presenting comparable outcomes, as well as the absence of studies with a direct comparison of different surgical techniques, may result in confusion. We provide a structured and comprehensive overview of the different surgical options currently available for the secondary repair of refractory and recurrent FTMHs. In addition to an update on epidemiology, diagnosis and description of the surgical steps, we highlight the evidence available to support each of the described surgical techniques, specifically focusing on the presumed mechanisms of hole closure, advantages, and known prognostic factors.

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: Manuscript no. 2009-1265.

: Supported in part by research grants from the Ministry of Education, Science and Culture, Tokyo, Japan.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Original articleFoveal Microstructure and Visual Acuity in Surgically Closed Macular Holes: Spectral-Domain Optical Coherence Tomographic Analysis

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Patients and Methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane: update of a prospective study

Retina

Original article
Foveal Microstructure and Visual Acuity in Surgically Closed Macular Holes: Spectral-Domain Optical Coherence Tomographic Analysis