The Evaluation of Prognostic Factors after Vitrectomy for Lamellar Macular Hole Using Optical Coherence Tomography

Sang Won Kim; Hye Min Jeon; Dong Seob Ahn; Hee Seong Yoon

doi:10.3341/jkos.2014.55.12.1853

Journal List > J Korean Ophthalmol Soc > v.55(12) > 1009869

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Jeon, Ahn, and Yoon: The Evaluation of Prognostic Factors after Vitrectomy for Lamellar Macular Hole Using Optical Coherence Tomography

Original Article

J Korean Ophthalmol Soc 2014;55(12):1853-1859.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.12.1853

The Evaluation of Prognostic Factors after Vitrectomy for Lamellar Macular Hole Using Optical Coherence Tomography

Sang Won Kim, MD, Hye Min Jeon, MD, Dong Seob Ahn, MD, Hee Seong Yoon, MD

Sungmo Eye Hospital, Busan, Korea

Address reprint requests to Hee Seong Yoon, MD Sungmo Eye Hospital, #409-1 Haeun-daero, Haeundae-gu, Busan 612-823, Korea, Tel: 82-51-743-0775, Fax: 82-51-743-0776, E-mail: heesyoon@dreamwiz.com

Received 31 May 2014 Revised 11 August 2014 Accepted 5 November 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the prognostic factors that predict visual outcome after vitrectomy for lamellar macular hole using optical coherence tomography (OCT).

Methods

This study included 26 eyes that underwent pars plana vitrectomy, epiretinal membrane removal, and internal limiting membrane peeling for lamellar macular hole. The maximum parafoveal thickness, maximum height and diameter of lamellar macular hole, maximum height and diameter of intraretinal splitting, thinnest foveal floor thickness, and inner segment/outer segment disruption length on preoperative OCT image were investigated for prognostic factors that predict visual outcome.

Results

The mean follow-up period was 32.2 months and the mean best corrected visual acuity improved significantly after vitrectomy from log MAR 0.47 ± 0.32 to log MAR 0.23 ± 0.23. The postoperative visual acuity correlated significantly with preoperative visual acuity, thinnest foveal floor thickness and inner segment/outer segment disruption length, but not with maximum parafoveal thickness, maximum height and diameter of lamellar macular hole and maximum height and diameter of intraretinal splitting.

Conclusions

The thinnest foveal floor thickness and inner segment/outer segment disruption length on preoperative OCT image were significant prognostic factors.

Keywords: Lamellar macular hole, Optical coherence tomography, Prognostic factors

References

1. Gass JD. Lamellar macular hole: a complication of cystoid macular edema after cataract extraction: a clinicopathologic case report. Trans Am Ophthalmol Soc. 1975; 73:231–50.

2. Witkin AJ, Ko TH, Fujimoto JG, et al. Redefining lamellar holes and the vitreomacular interface: an ultrahigh-resolution optical coherence tomography study. Ophthalmology. 2006; 113:388–97.

3. Theodossiadis PG, Grigoropoulos VG, Emfietzoglou I, et al. Evolution of lamellar macular hole studied by optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2009; 247:13–20.

4. Chen JC, Lee LR. Clinical spectrum of lamellar macular defects including pseudoholes and pseudocysts defined by optical coherence tomography. Br J Ophthalmol. 2008; 92:1342–6.

5. Takahashi H, Kishi S. Tomographic features of a lamellar macular hole formation and a lamellar hole that progressed to a full-thickness macular hole. Am J Ophthalmol. 2000; 130:677–9.

6. Lee SJ, Jang SY, Moon D, et al. Long-term surgical outcomes after vitrectomy for symptomatic lamellar macular holes. Retina. 2012; 32:1743–8.

7. Michalewska Z, Michalewski J, Odrobina D, et al. Surgical treatment of lamellar macular holes. Graefes Arch Clin Exp Ophthalmol. 2010; 248:1395–400.

8. Haouchine B, Massin P, Gaudric A. Foveal pseudocyst as the first step in macular hole formation: a prospective study by optical coherence tomography. Ophthalmology. 2001; 108:15–22.

9. Garretson BR, Pollack JS, Ruby AJ, et al. Vitrectomy for a symptomatic lamellar macular hole. Ophthalmology. 2008; 115:884–6.e1.

10. Choi WS, Kim SW, Lee WS, et al. Visual and surgical outcomes of lamellar macular hole. J Korean Ophthalmol Soc. 2012; 53:1291–5.

11. Suh MH, Seo JM, Park KH, Yu HG. Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal. Am J Ophthalmol. 2009; 147:473–80.e3.

12. Inoue M, Morita S, Watanabe Y, et al. Preoperative inner segment/outer segment junction in spectral-domain optical coherence tomography as a prognostic factor in epiretinal membrane surgery. Retina. 2011; 31:1366–72.

13. Lee CS, Koh HJ, Lim HT, et al. Prognostic factors in vitrectomy for lamellar macular hole assessed by spectral-domain optical coherence tomography. Acta Ophthalmol. 2012; 90:e597–602.

14. Frangieh GT, Green WR, Engel HM. A histopathologic study of macular cysts and holes. Retina. 1981; 1:311–36.

15. Guyer DR, Green WR, de Bustros S, Fine SL. Histopathologic features of idiopathic macular holes and cysts. Ophthalmology. 1990; 97:1045–51.

16. Chang LK, Koizumi H, Spaide RF. Disruption of the photoreceptor inner segment-outer segment junction in eyes with macular holes. Retina. 2008; 28:969–75.

17. Chung H, Shin CJ, Kim JG, et al. Correlation of microperimetry with fundus autofluorescence and spectral-domain optical coherence tomography in repaired macular holes. Am J Ophthalmol. 2011; 151:128–36.e3.

Figure 1.

Presumed prognostic factor of spectral-domain optical coherence tomography. The pink arrow indicates the maximum parafovea thickness; the blue arrow indicates the maximum height of lamellar macular hole; the green arrow indicates the maximum diameter of lamellar macular hole; the yellow arrow indicates the maximum height of intraretinal splitting; the white arrow indicates the maximum diameter of intraretinal splitting; the red arrow indicates thinnest foveal floor thickness; the orange arrow indicates inner segment/outer segment disruption length.

Figure 2.

Mean best corrected visual acuity (log MAR) changes after treatment. BCVA of 26 eyes showed statistically significant improvement at each time after treatment (p < 0.05, Wilcoxon signed rank test). BCVA = best corrected visual acuity.

Table 1.

Preoperative and postoperative demographics and clinical characteristics of the patients

Characteristics	Values
Mean age (years)	65.92 ± 8.73
Sex (M:F) (%)	5 (19):21 (81)
Mean follow-up (months)	32.21 ± 9.15
Preoperative BCVA (log MAR)	0.47 ± 0.32
Postoperative BCVA (2 months) (log MAR)	0.31 ± 0.21
Postoperative BCVA (6 months) (log MAR)	0.25 ± 0.22
Postoperative BCVA (final) (log MAR)	0.23 ± 0.23
Mean BCVA change (log MAR)	0.21 ± 0.24
Improved BCVA (no. of eyes, %)	22 (84.6)
Unchnaged BCVA (no. of eyes, %)	2 (7.7)
Worsened BCVA (no. of eyes, %)	2 (7.7)

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity.

Table 2.

Presumed prognostic factor of spectral-domain optical coherence tomography in lamellar maucular hole

Preoperative prognostic factor	Values
Maximum parafovea thickness (μm)	431.52 ± 63.63
Maximum height of hole (μm)	250.52 ± 63.68
Maximum diameter of hole (μm)	494.52 ± 156.78
Maximum height of intraretinal splitting (μm)	164.32 ± 46.01
Maximum diameter of intraretinal splitting (μm)	1,687.52 ± 508.54
Thinnest foveal floor thickness (μm)	132.88 ± 49.48
Postoperative central macular thickness (μm)	320.96 ± 63.03
Inner segment/outer segment disruption (no. of eyes, %)	6 (23.1)
Inner segment/outer segment disruption length (μm)	604.11 ± 363.85

Values are presented as mean ± SD unless otherwise indicated.

Table 3.

Correlation between BCVA and optical coherence tomography parameters

	Preoperative BCVA (log MAR)		Postoperative BCVA (log MAR)		Postoperative visual improvement (log MAR)
	Coefficient^*	p-value	Coefficient^*	p-value	Coefficient^*	p-value
Preoperative BCVA (log MAR)			0.61	0.002^†	0.738	<0.001^†
Maximum parafovea thickness (μm)	−0.163	0.447	0.007	0.975	−0.181	0.396
Maximum height of hole (μm)	−0.077	0.722	0.059	0.783	−0.116	0.588
Maximum diameter of hole (μm)	0.146	0.497	−0.073	0.733	0.104	0.63
Maximum height of intraretinal splitting (μm)	−0.242	0.254	0.051	0.813	−0.273	0.197
Maximum diameter of intraretinal splitting (μm)	0.267	0.207	0.181	0.396	0.155	0.47
Thinnest foveal floor thickness (μm)	−0.425	0.038^†	−0.454	0.026^†	−0.15	0.483
IS/OS disruption length (μm)	0.357	0.087	0.617	0.001^†	−0.012	0.955

BCVA = best corrected visual acuity; IS/OS = photoreceptor inner and outer segment junction.

^* Spearman's rho correlation coefficient;

^† Statistically significant.

TOOLS

Similar articles