External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis (original) (raw)
Related papers
American Journal of Ophthalmology, 2011
IOANNIS EMFIETZOGLOU, VLASSIS G. GRIGOROPOULOS, AND VASILIOS S. LIARAKOS • PURPOSE: To study the prognostic factors that influence best-corrected visual acuity (BCVA) outcome in patients with secondary epiretinal membrane (ERM) after retinal detachment surgery. • DESIGN: Retrospective case series. • METHODS: Forty-two patients with ERM were divided into macula-on and macula-off groups based on the macular status before retinal detachment surgery and were studied using the same spectral-domain optical coherence tomography device. Several variables, including the integrity of the external limiting membrane (ELM), the status of the photoreceptor inner segment/ outer segment (IS/OS) junction line, and central foveal thickness were evaluated in 17 treated and 25 untreated patients. Linear regression analysis was used to determine the best combination of all variables affecting BCVA. • RESULTS: Final BCVA was significantly better in macula-on and macula-off eyes with intact ELMs and IS/OS junction lines (0.35 ؎ 0.18 logarithm of the minimal angle of resolution [logMAR] and 0.51 ؎ 0.17 logMAR, respectively) than in macula-off eyes with disrupted or absent ELMs and IS/OS junction lines (0.83 ؎ 0.17 logMAR and 1.04 ؎ 0.05 logMAR, respectively; P < .001, analysis of variance). Final BCVA also was better in the treated group than in the controls (0.55 ؎ 0.31 logMAR and 0.73 ؎ 0.26 log-MAR, respectively; P ؍ .05, t test). ELM and IS/OS junction line integrity were the main variables significantly affecting the final BCVA outcome ( ؍ 0.42; P ؍ .006, linear regression analysis). Disruption of the ELM and IS/OS junction line was observed in 21 of the 42 cases studied. • CONCLUSIONS: ERM secondary to retinal detachment surgery is accompanied by a high incidence (50%) of IS/OS junction line and ELM disruption. Among the variables studied, the condition of the IS/OS junction layer and the ELM are the main factors that predict final BCVA after ERM peeling. (Am J Ophthalmol 2011; 151:973-980.
Retina (Philadelphia, Pa.), 2017
To investigate the correlation between preoperative en face spectral domain optical coherence tomography findings of the photoreceptor layer with restoration of foveal microstructure and visual acuity in repaired macular holes. Medical records of 106 patients with surgically closed macular holes were retrospectively reviewed. Preoperative OCT slabs of the external limiting membrane (ELM) and ellipsoid zone (EZ) were generated using embedded tools. All patients were classified into two groups according to the presence of preoperative retinal pigment epithelium protrusion seen as hyperreflective spots in EZ slab. Visual acuity, homogenous reflectivity, and glial proliferation in the ELM and EZ slabs were followed for 12 months. Baseline hyperreflective spots in the EZ slab was observed in 51 (48.1%) eyes. Postoperative homogenous reflectivity and glial proliferation were related to the presence of baseline hyperreflective spots. Vision improvement was significantly greater in the abse...
● PURPOSE: Study correlation between optical coherence tomography (OCT) findings and visual acuity (VA) outcomes after successful macular hole surgery (MHS). ● DESIGN: Retrospective cross-sectional study. ● METHODS: Postoperative OCT scans were analyzed in 34 eyes of 30 patients. Raw files of horizontal and vertical OCT scans were exported to Adobe Photoshop 7.0. Measured parameters included central foveal thickness , photoreceptor thickness, photoreceptor reflectivity, and relative reflectivity of photoreceptor to retinal pigment epithelium in the foveal area. Foveal configuration was subjectively graded. ● RESULTS: OCT scans were obtained at a median of 2 years (1 month to 10 years) postoperatively. The median visual acuity was 20/80 (20/50 to 8/200) preoperatively and 20/50 (20/20 to 5/200) postoperatively. The median foveal thickness was 198.5 (148 to 283). The mean (SD) photoreceptor layer thickness was 16.5 (8) in the 500 area and 17.5 (8) in the 1000 area. Mean (SD) of relative reflectivity of the photoreceptor layer was 0.60 (0.10) in both 500 and 1000 area. Postoperative VA did not correlate with foveal thickness or foveal configuration. Central (500 and 1000) photoreceptor thickness was significantly correlated with final VA (r .38, P .026, each). Relative reflectivity of photoreceptors to retinal pigment epithelium in the 500 area was correlated with postoperative VA at a borderline significance (r .32, P .07). Relative reflectivity of photoreceptors to retinal pigment epithe-lium in the 1000 area was not significantly correlated with postoperative VA (r .27, P .12). ● CONCLUSION: Specific retinal features can be assessed from OCT images. Morphology and thickness of the foveal photoreceptor layer correlate well with macular function after successful MHS. Outer retinal features appear to be more important to determine postoperative visual function. Inner retinal features may be more relevant for the ophthalmoscopic appearance of anatomic closure. (Am J Ophthalmol 2005;139:280 –289.
Investigative ophthalmology & visual science, 2010
To evaluate photoreceptor inner/outer segment (IS/OS) defect parameters by using spectral domain-optical coherence tomography (SD-OCT) for correlation with visual outcomes in macular hole surgery (MHS). This study was an interventional, retrospective case series. Twenty-three eyes (23 patients) were examined by SD-OCT before and after (median, 2.3 months) anatomically successful MHS. Two formats of OCT were analyzed: linear (raster) and composite (partial fundus image). Factors that may have confounded IS/OS measurements were controlled by using weighting and normalization of data. The main outcome measures were diameter and area of the IS/OS defect, weighted area of the IS/OS defect, macular density ratio (MDR), healing pattern of the macular hole, and preoperative and postoperative best corrected visual acuity (BCVA). Poorer preoperative BCVA correlated with larger preoperative diameter of the IS/OS defect (P = 0.005). A greater improvement in BCVA correlated with a larger preoper...
Graefe's Archive for Clinical and Experimental Ophthalmology, 2010
To report on changes in retinal morphology during the 12 months after macular hole surgery. Seventy one eyes of 66 patients after pars plana vitrectomy with ILM peeling and air tamponade were evaluated with spectral OCT for 12 months and additionally before surgery. Macular hole size was measured. On consecutive visits, the size of photoreceptor layer defects and elevation of the outer retinal layers were measured. Additionally, changes in foveal contour, nerve fibre layer defects, and retinal pigment epithelium defects were evaluated. Photoreceptor defects were observed in 66 eyes (93%) 1 week after surgery, and in only 21 eyes (29.5%) 12 months after surgery. The linear photoreceptor defect continuously decreased in size with time (from the mean of 882 microm 1 week after surgery to 60 microm 12 months after surgery). Elevations of the outer retinal layers were observed in 42 eyes (59%) 1 month after surgery and in six eyes (8.4%) 12 months after surgery. Nerve fibre layers defects (observed in 17 cases; 24%) and retinal pigment epithelium defects (present in four eyes, 3%) did not change with time. Macular holes close with a bridge-like glial proliferation. The size of the elevation of outer retinal layers decreases with time. Photoreceptor defects get continuously smaller for at least 12 months postoperatively, which statistically significantly correlates with visual acuity improvement (p &amp;amp;amp;amp;amp;lt; 0.01). Additionally, foveal contour improves with time. Possible mechanisms are glial cells pushing the photoreceptors onto new positions or restoration of the outer segments from the intact photoreceptor body.
Long-Term Anatomic and Functional Outcomes after Macular Hole Surgery
Journal of Ophthalmology, 2018
Aim. To evaluate the structural and functional outcomes in patients who underwent macular hole (MH) surgery in the long-term follow-up. Materials and Methods. Forty-four eyes of 40 patients (28 females and 12 males) were examined. The examination included visual acuity, optical coherence tomography, and colour vision testing. The same evaluation was performed in 30 fellow eyes. Results. MH closure was obtained in 42 eyes (95.45%). There was no reopening of the initially closed MHs. In long-term postoperative examination, we observed IS/OS junction defects in 28 (63.6%) eyes and ELM defects in 19 (43.2%) eyes. We found that the IS/OS junction defects correlated with the diameter of the MH (p=0.016), whereas ELM defects correlated with both the diameter of the MH (p=0.001) and duration time of the MH (p=0.008). The presence of ELM defects in OCT was the cause of inferior BCVA in long-term observation time (p=0.004). The mean BCVA before the MH surgery was 0.15. It improved significant...
Long-Term Structural and Functional Outcomes After Macular Hole Surgery
Retina, 2016
Purpose: To assess the long-term visual outcomes of macular hole surgery and to correlate structural changes on spectral domain optical coherence tomography after surgery with long-term changes in the best-corrected visual acuity. Methods: A prospective study looking at 36 patients who underwent macular hole surgery between 2008 and 2010. The main outcome measure was change in the bestcorrected visual acuity from 4 months to 6 months after surgery until the study visit. Changes in optical coherence tomography thickness and the morphology of the ellipsoid layer at the 4-month to 6-month scan were also analyzed. Results: Over a mean follow-up of 36 months, the best-corrected visual acuity continues to improve from a median of 20/63 at 4 months to 6 months postoperatively to a median of 20/47 at the final study visit (P , 0.01). There was a median gain of 6.5 letters (logMAR 0.13). Seven of 36 patients (20%) improved from nondriving visual acuity at 4 months to 6 months after surgery to driving visual acuity ($20/40) at the final study visit. The presence of an intact ellipsoid layer at the 4-month to 6-month postoperative optical coherence tomography scan may represent a trend for long-term improvement in visual acuity (Fisher's exact test, P = 0.07). Conclusion: The best-corrected visual acuity continues to improve beyond 4 months to 6 months after macular hole surgery. Reconstruction of the ellipsoid layer in the early postoperative period may help predict, which patients are likely to have subsequent longterm improvement in visual acuity. This information may help clinicians counsel patients appropriately and help explain cases of unsatisfactory visual improvement after surgery.
Graefe's archive for clinical and experimental ophthalmology, 2024
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.
Turkish Journal of Ophthalmology, 2020
Objectives: To assess changes in reflectivity of the retinal pigment epithelium (RPE), ellipsoid zone (EZ), and external limiting membrane (ELM) on spectral domain-optical coherence tomography (SD-OCT) images and the effects of reflectivity changes on visual acuity improvement after vitrectomy in macular hole patients. Materials and Methods: Twenty-four eyes of 24 patients with idiopathic full-thickness macular hole closed after vitrectomy were retrospectively reviewed. The "plot profile" function of the medical imaging software was used by a single masked physician to analyze RPE, EZ, and ELM reflectivity on OCT images at postoperative 1 month and 12 months. Results: Absolute and relative EZ reflectivity showed highly significant increases at postoperative 12 months compared to 1 month (p<0.001 and p<0.001, respectively). Absolute and relative EZ reflectivity changes from postoperative month 1 to month 12 after macular hole surgery were significantly correlated with best corrected visual acuity improvement (p=0.012 and p=0.020, respectively). Conclusion: EZ reflectivity can be a predictor of functional and anatomical improvement after macular hole surgery.