Purpose: A variety of retinal topographical changes occur after internal limiting membrane (ILM) peeling for macular holes including a movement of the fovea toward the optic nerve. This study was carried out to assess the effect of the extent of ILMpeeled area on these changes and postoperative visual acuity. Methods: Prospective single-center study of a consecutive series of patients undergoing macular hole surgery. Preoperative and postoperative optical coherence tomography images were used to assess a variety of measures of retinal morphology. Transmission electron microscopy of the peeled ILM was used to assess residual retinal and vitreous side debris. The area of the ILM peeled was calculated from intraoperative images. Results: Fifty-six eyes of 56 patients were included. The mean area of ILM peeled was 9.5 mm 2 (2.4-28.3 mm 2 ). The mean disc-to-fovea distance (DFD) preoperatively was 3703 mm with a mean reduction of 52 mm postoperatively, representing a change of À1.29% with a wide range of À7.04% to 1.36%. Using stepwise linear regression, ILM-peeled area was significantly associated with a change in DFD (P < .001), extent of a dissociated optic nerve fiber layer appearance (P < .001), and postoperative visual acuity (P ¼ .025). Nasotemporal retinal thickness asymmetry was associated with the minimum linear diameter (P < .001). Conclusion: The ILM-peeled area has a significant effect on changes in retinal topography and postoperative visual acuity separate from macular hole size. Further study is needed to assess the effect of ILM peeled size on visual function and to guide clinical practice.
ObjectiveFull-thickness macular holes (MH) are classified principally by size, which is one of the strongest predictors of anatomical and visual success. Using a three-dimensional (3D) automated image processing algorithm, we analysed optical coherence tomography (OCT) images of 104 MH of patients, comparing MH dimensions and morphology with clinician-acquired two-dimensional measurements.Methods and AnalysisAll patients underwent a high-density central horizontal scanning OCT protocol. Two independent clinicians measured the minimum linear diameter (MLD) and maximum base diameter. OCT images were also analysed using an automated 3D segmentation algorithm which produced key parameters including the respective maximum and minimum diameter of the minimum area (MA) of the MH, as well as volume and surface area.ResultsUsing the algorithm-derived values, MH were found to have significant asymmetry in all dimensions. The minima of the MA were typically approximately 90° to the horizontal, and differed from their maxima by 55 μm. The minima of the MA differed from the human-measured MLD by a mean of nearly 50 μm, with significant interobserver variability. The resultant differences led to reclassification using the International Vitreomacular Traction Study Group classification in a quarter of the patients (p=0.07).ConclusionMH are complex shapes with significant asymmetry in all dimensions. We have shown how 3D automated analysis of MH describes their dimensions more accurately and repeatably than human assessment. This could be used in future studies investigating hole progression and outcome to help guide optimum treatments.
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