External limiting membrane angle as a composite predictive index for post-operative ELM closure in full thickness macular holes

Nair, Unnikrishnan; Menon, Rahul R; Mohan, Ashwin; Vijayan, Amritha; Indurkar, Asmita; Soman, Manoj

doi:10.1007/s00417-020-04949-5

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…6,7 Various macular indices like MH minimum and base diameter, the MH height, Diameter Hole Index (DHI), Tractional Hole Index (THI), and Macular Hole Index (MHI) and even ELM angle have been studied to predict closure and visual acuity gains. [8][9][10] Cystic changes have been demonstrated both in the inner and outer layers of the retina on histopathological evaluation of enucleated eyes with macular holes. 11 These hypore ective intraretinal cystoid spaces surrounding the full-thickness macular hole have also been studied previously on en face SD-OCT imaging.…”

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confidence: 99%

Intraretinal cysts in Macular Hole: A structure-function correlation based on en face imaging

Nair

Sheth

Indurkar

et al. 2021

Preprint

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This study determines and characterizes the role of retinal micromorphic changes on en-face optical-coherence tomography(OCT) in macular-hole(MH) surgery. Pre-and post-operative parameters including MH basal-diameter(BD) and minimal inlet-area(MIA), inner-plexiform layer(IPL) and outer-plexiform layer(OPL) cyst-area, IPL and OPL cyst-percentage, and amount of defect in ellipsoid-zone(EZ) and external-limiting membrane(ELM) were compared amongst 28 eyes undergoing successful MH surgery. Their relationship with visual-acuity(VA) outcomes(Group-1: ≥ 20/60;14 eyes; Group-2: < 20/60;14 eyes) was also evaluated. We noted a significant positive correlation between the OPL and IPL cyst-area(r = 0.768;p < 0.001), which in turn were positively correlated with the MH-BD in all eyes. The cyst area was significantly more in IPL as compared to OPL in all eyes (p = 0.049) and in group-2(p = 0.03), but not in group-1(p = 0.62). As compared to group-2, eyes in group-1 had significantly better pre-and post-operative-VA, and significantly smaller BD, MIA, IPL and OPL cyst-area, and ELM(post-operative) and EZ(Pre-and post-operative) defect, respectively. To conclude, an increase in the MH-BD is associated with a simultaneous congruous enlargement of the IPL and OPL cyst-area. The origin of intraretinal cysts could be secondary to breakdown in the physiological retinal-pigment epithelium(RPE) pump due to the anatomical separation of the neurosensory retina from the underlying RPE, i.e., "RPE contact-loss" theory.

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Section: Introductionmentioning

confidence: 99%

Intraretinal cysts in Macular Hole: A structure-function correlation based on en face imaging

Nair

Sheth

Indurkar

et al. 2021

Preprint

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“…6,7 Various macular indices like MH minimum and base diameter, the MH height, Diameter Hole Index (DHI), Tractional Hole Index (THI), and Macular Hole Index (MHI) and even ELM angle have been studied to predict closure and visual acuity gains. [8][9][10] Cystic changes have been demonstrated both in the inner and outer layers of the retina on histopathological evaluation of enucleated eyes with macular holes. 11 These hyporeflective intraretinal cystoid spaces surrounding the full-thickness macular hole have also been studied previously on en face SD-OCT imaging.…”

Section: Introductionmentioning

confidence: 99%

Intraretinal Cysts in Macular Hole: A Structure-Function Correlation Based on En Face Imaging

Nair¹,

Sheth²,

Indurkar³

et al. 2021

OPTH

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Purpose: To characterize retinal micromorphic changes on en face optical coherence tomography (OCT) and to determine their role in pathogenesis and visual outcomes in macular hole (MH) surgery. Patients and Methods: This is a retrospective, interventional, consecutive case series of 28 eyes undergoing successful MH surgery. Pre-and post-operative en face OCT were manually segmented, and the correlation between parameters such as MH basal diameter and minimal inlet area, area of cyst in inner plexiform layer (IPL) and outer plexiform layer (OPL), percentage of cyst in IPL and OPL, and amount of ellipsoid zone (EZ) defect and external limiting membrane (ELM) defect was performed. Their relationship with visual acuity (VA) outcomes (Group 1: ≥20/60; 14 eyes; Group 2: <20/60; 14 eyes) was also evaluated. Results: A significant positive correlation was noted between the cyst area in OPL and IPL (r=0.768; p<0.001), which in turn were positively correlated with the basal diameter of the MH in all eyes. The cyst area was significantly more in IPL as compared to OPL in all eyes (p=0.049) and in group 2 (p=0.03) but not in group 1 (p=0.62). As compared to group 2, eyes in group 1 had significantly better pre-and post-operative VA, and significantly smaller basal diameter, minimal inlet area, area of cyst in IPL and OPL, and amount of defect in the ELM (postoperative) and EZ (pre-and post-operative), respectively. Conclusion: An increase in the basal diameter of the MH is associated with a simultaneous congruous enlargement of the area of cyst in IPL and OPL. Based on these imaging findings, we propose that the possible rationale for the origin of these intraretinal cysts could be a breakdown in the physiological retinal pigment epithelium (RPE) pump due to the anatomical separation of the neurosensory retina from the underlying RPE, ie, "RPE contact loss" theory.

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“…[ 11 ] Following type-1 closure, reconstruction of the foveal ELM is known to help in predicting subsequent foveal photoreceptor layer restoration and the potential for better visual outcomes. [ 12 ] On baseline OCT, the ELM band is known to extend within the walls surrounding the FTMH, whereas the EZ band may stop at the edge of the walls. [ 13 ] We noticed the absence of both bands (ELM and EZ) in the walls of the FTMH in a patient who showed type-1 closure following vitrectomy.…”

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Indistinct retinal outer layers in the walls of the idiopathic full-thickness macular hole - A potential predictive biomarker for surgical outcomes

Patel

Delhiwala

Khamar

2022

Indian Journal of Ophthalmology

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Purpose: To evaluate the absence of external limiting membrane (ELM) and ellipsoid zone (indistinct retinal outer layers, I-ROL) in the walls of idiopathic full-thickness macular holes (FTMHs) circumferentially on optical coherence tomography (OCT) and its correlation with surgical outcome. Methods: In this retrospective observational study, OCT images of patients undergoing vitrectomy for FTMHs with at least 3-months of postoperative follow-up were analyzed for preoperative circumferential extent of I-ROL. Derived macular hole indices such as hole form factor (HFF), macular hole index (MHI), tractional hole index (THI), and hole diameter ratio (HDR) were also calculated. The circumferential extent of I-ROL was correlated with derived hole indices as well as anatomical closure, foveal architecture, and restoration of ELM following surgery. Results: All nine eyes (eight patients) with FTMH (mean size: 610.11 ± 122.95 microns) in the study showed I-ROL in ≥1 quadrant. The mean HFF, MHI, THI, and HDR values were 0.72 ± 0.09, 0.35 ± 0.05, 0.71 ± 0.24, and 0.53 ± 0.14, respectively. All eyes achieved type-1 hole closure with improvement in best-corrected visual acuity to 0.58 ± 0.32 LogMAR from 0.81 ± 0.26 LogMAR. Regular foveal architecture was achieved in six eyes. Out of these, five eyes had I-ROL in ≥2 quadrants, and one eye had I-ROL in <2 quadrants ( P = 0.0476). Restoration of ELM was seen in aforementioned six eyes (complete = 5, partial = 1). Out of the five eyes with complete ELM restoration, four had a circumferential extent of I-ROL in ≥2 quadrants ( P = 0.0476). Complete restoration of ELM was associated with the complete restoration of the ellipsoid zone in three eyes. Conclusion: Preoperative circumferential extent of I-ROL in FTMH walls can be a potential predictive OCT marker for the type of closure, postoperative foveal architecture, and ELM restoration.

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External limiting membrane angle as a composite predictive index for post-operative ELM closure in full thickness macular holes

Cited by 5 publications

References 13 publications

Intraretinal cysts in Macular Hole: A structure-function correlation based on en face imaging

Intraretinal cysts in Macular Hole: A structure-function correlation based on en face imaging

Intraretinal Cysts in Macular Hole: A Structure-Function Correlation Based on En Face Imaging

Indistinct retinal outer layers in the walls of the idiopathic full-thickness macular hole - A potential predictive biomarker for surgical outcomes

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