Hole diameter ratio for prediction of anatomical outcomes in stage III or IV idiopathic macular holes

Qi, Yue; Yu, Yanping; You, Qi Sheng; Wang, Zengyi; Wang, Jing; Liu, Wu

doi:10.1186/s12886-020-01614-7

Cited by 8 publications

(8 citation statements)

References 32 publications

(66 reference statements)

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“…Qi et al . [ 21 ] in their study on 101 patients with stage-3 and stage-4 holes found HDR ( P = 0.01) to be significantly different in the two groups (hole closed and un-closed), influencing closure rate with larger holes.…”

Section: Discussionmentioning

confidence: 97%

Postoperative microstructural re-modelling and functional outcomes in idiopathic full thickness macular hole

Dronadula

Bodhankar²,

Joshi³

et al. 2022

Indian Journal of Ophthalmology

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Purpose: To analyze the effect of various macular hole indices and postoperative microstructural changes of all retinal layers on postoperative functional outcomes in patients with idiopathic full-thickness macular hole (FTMH). Methods: In this prospective study, pre and post-operative optical coherence tomography (OCT) scans of 36 eyes with idiopathic FTMH were analyzed. Hole indices and microstructural changes of all retinal layers such as ellipsoid zone (EZ), external limiting membrane (ELM) integrity, outer and inner retinal defects, and cystoid resolution were studied on follow-up visits. Results: Out of 36 eyes, type-1 closure was achieved in 23 eyes (65.7%) and type-2 closure in 11 eyes (31.42%), one eye showed persistent hole, and one eye was lost to follow-up. The mean minimum diameter of hole ( P = 0.026), mean MHI ( P = 0.001), DHI ( P = 0.158), THI ( P = 0.001), and HFF ( P < 0.001) showed statistical significance with the type of hole closure. Postoperatively, eyes with intact ELM and EZ had better BCVA at the final visit. The BCVA was better by logMAR 0.73 ± 0.38 ( P < 0.001) in patients with absent outer retinal defects. There was a significant difference in BCVA of 0.52 ± 0.35 at 1 month and 0.64 ± 0.34 at 6 months in eyes without inner retinal defects ( P < 0.001). At 6 months, cystoid resolution was observed in 28 (80%) eyes. BCVA was significantly better at 1 month ( P < 0.001) and at 6 months ( P = 0.001) in eyes with no DONFL. Conclusion: Macular hole indices determine the closure type. Postoperative regeneration of outer retinal layers and resolution of retinal defects significantly influence the final visual outcomes. ELM recovery is seen as a prerequisite for EZ regeneration with no new IRD after a period of 3 months.

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Section: Discussionmentioning

confidence: 97%

Postoperative microstructural re-modelling and functional outcomes in idiopathic full thickness macular hole

Dronadula

Bodhankar²,

Joshi³

et al. 2022

Indian Journal of Ophthalmology

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“…Similarly, HDR primarily represents tangential traction, and eyes with a preoperative HDR value of < 0.6 have a higher chance of achieving type-I closure. [ 11 ] Based on the above understanding, elimination of tractional components following surgery should increase the chances of predominantly type-1 closure. However, some indices such as MHI, THI, and HDR have been found to predict type-1 closure, whereas outer diameter and DHI have been found to predict type-2 closure.…”

Section: Discussionmentioning

confidence: 99%

“…From these values, derived hole indices such as HFF, MHI, THI, and HDR were calculated as described in previous studies. [ 6 7 8 11 ]…”

Section: Methodsmentioning

confidence: 99%

“…Some of these well-known parameters include minimum linear diameter, basal diameter, macular hole index (MHI), hole form factor (HFF), tractional hole index (THI), hole diameter ratio (HDR), and area indices. [ 5 6 7 8 9 10 11 ] Among them, MHI and THI can predict type-1 closure. [ 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.…”

mentioning

confidence: 99%

“…[ 5 6 7 8 9 10 11 ] Among them, MHI and THI can predict type-1 closure. [ 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.…”

mentioning

confidence: 99%

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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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Prediction of long-term visual outcome of idiopathic full-thickness macular hole surgery using optical coherence tomography parameters that estimate potential preoperative photoreceptor damage

Bajdik,

Vajas,

Kemenes

et al. 2024

Graefes Arch Clin Exp Ophthalmol

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Purpose To identify optical coherence tomography (OCT) parameters that predict postoperative best corrected visual acuity (BCVA) and are based on recent understanding of the pathomechanism of idiopathic full thickness macular hole (iFTMH) formation and closure. Methods A retrospective consecutive case series of patients who had macular hole (MH) surgery at our institution between 2016 and 2022 was performed. 32 eyes of 30 patients were selected with at least 12 months of follow-up, closed MH and good quality OCT at each visit. Univariate correlation analysis, multiple logistic regression with forward stepwise selection, and Akaike’s Information Criterion (AIC) were used to identify the best predictors for postoperative BCVA at 6 and 12 months (M), and final (≥ 12 M) visits, and a new OCT index was created. Abilities of best models/indices to predict < 0.30 logMAR (> 20/40) BCVA were compared to macular hole index (MHI) using the area under the receiver operating curve (AU-ROC) analysis. Results Statistical analysis revealed base diameter (B) (6 M), preoperative BCVA and B (12 M) and smaller ELM-GCL distance (A), and B (final visit) as predictors for postoperative BCVA. AU-ROC analysis indicated greatest AUC at 6 M for MHI and B (0.797, p = 0.004 and 0.836 p = 0.001, respectively) and for the new A/B index at 12 M and final visit (0.844, p = 0.002 and 0.913, p = 0.003, respectively). Conclusion Our study suggests that MHI and B can be useful predictors of short term BCVA while the new A/B index that incorporates OCT parameters indicating potential preoperative photoreceptor damage may be a good predictor for long term postoperative BCVA. Our findings support the theory that initial hole formation mechanisms and photoreceptor damage define visual prognosis.

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Hole diameter ratio for prediction of anatomical outcomes in stage III or IV idiopathic macular holes

Cited by 8 publications

References 32 publications

Postoperative microstructural re-modelling and functional outcomes in idiopathic full thickness macular hole

Postoperative microstructural re-modelling and functional outcomes in idiopathic full thickness macular hole

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

Prediction of long-term visual outcome of idiopathic full-thickness macular hole surgery using optical coherence tomography parameters that estimate potential preoperative photoreceptor damage

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