Skip to main content

Advertisement

SpringerLink
Log in

Macular hole closure patterns: an updated classification

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

The classification of macular hole closure patterns (MHCPs) currently relies on time domain OCT allowing only “open” and “closed” statuses or is based on inner foveal contour shape. Both classification types give no information on retinal layer reconstitution. Novel sophisticated surgical techniques lead to previously unknown MHCPs, outdating existing classifications and urging new ones. The purpose of the present study is to introduce a new classification allowing proper description of all MHCPs resulting from newer surgeries and based on the restoration of retinal layers.

Methods

Retrospective analysis of patients undergoing MH surgery with five different surgical techniques was performed. MHCPs were classified according to spectral domain optical coherence tomography (SD-OCT). Type 0: open MH (0A: flat margin, 0B: elevated, 0C: oedematous); type 1: closed MHs (1A: reconstitution all retinal layers; 1B interruption of the external layers; 1C interruption of internal layers); type 2: MH closed with autologous or heterologous filling tissue interrupting the normal foveal layered anatomy (2A: filling tissue through all layers; 2B reconstitution of normal inner retinal layers; 2C reconstitution of normal outer retinal layers; 2D H-shaped bridging of filling tissue).

Results

Closure rate was 95.2% (241/253). Surgical technique and vision correlated to closure pattern (p < 0.001). Type 1 MHCPs had the best post-operative visual acuity (VA) compared with type 2 and type 0 (p < 0.001). MHCPs 1A and 1C performed better than all others. MHCP at months 1 and 3 changed in 42/254 (16.5%) and remained stable in 212/254 (83.5%). Improvement in vision was higher in eyes with shifting closure pattern (0.57 ± 0.33 vs 0.51 ± 0.48 logMAR; p 0.021).

Conclusion

MHCP classification based on retinal layer restoration properly comprises post-operative anatomic morphologies. MHCPs correlate the surgical technique and post-operative visual outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Kelly NE, Wendel RT (1991) Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol 109:654–659

    Article  CAS  Google Scholar 

  2. Rossi T, Gelso A, Costagliola C, Trillo C, Costa A, Gesualdo C, Ripandelli G (2017) Macular hole closure patterns associated with different internal limiting membrane flap techniques. Graefes Arch Clin Exp Ophthalmol 255:1073–1078. https://doi.org/10.1007/s00417-017-3598-9

    Article  PubMed  Google Scholar 

  3. Parravano M, Giansanti F, Eandi CM, Yap YC, Rizzo S, Virgili G (2015) Vitrectomy for idiopathic macular hole. Cochrane Database Syst Rev 12:CD009080. https://doi.org/10.1002/14651858.CD009080.pub2 Review

    Article  Google Scholar 

  4. Michalewska Z, Michalewski J, Adelman RA, Nawrocki J (2010) Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 117:2018–2025. https://doi.org/10.1016/j.ophtha.2010.02.011 Epub 2010 Jun 11

    Article  PubMed  Google Scholar 

  5. Rossi T, Trillo C, Schubert HD, Telani S, Cirafici P, Ferrari D, Ripandelli G (2019) Folding the internal limiting membrane flap under perfluorocarbon liquid in large, chronic and myopic macular holes. Graefes Arch Clin Exp Ophthalmol 257:2367–2373. https://doi.org/10.1007/s00417-019-04439-3

    Article  CAS  PubMed  Google Scholar 

  6. Baumann C, Kaye S, Iannetta D, Sultan Z, Dwivedi R, Pearce I (2019) Effect of inverted internal limiting membrane flap on closure rate, postoperative visual acuity, and restoration of outer retinal layers in primary idiopathic macular hole surgery [published online ahead of print, 2019 Dec 10]. Retina. https://doi.org/10.1097/IAE.0000000000002707

  7. Rizzo S, Caporossi T, Tartaro R, Finocchio L, Franco F, Barca F, Giansanti F (2019) A human amniotic membrane plug to promote retinal breaks repair and recurrent macular hole closure. Retina 39(Suppl 1):S95–S103. https://doi.org/10.1097/IAE.0000000000002320

    Article  Google Scholar 

  8. Grewal DS, Mahmoud TH (2016) Autologous neurosensory retinal free flap for closure of refractory myopic macular holes. JAMA Ophthalmol 134:229–230. https://doi.org/10.1001/jamaophthalmol.2015.5237

    Article  PubMed  Google Scholar 

  9. Meyer CH, Szurman P, Haritoglou C et al (2020) Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study [published online ahead of print, 2020 Jun 24]. Graefes Arch Clin Exp Ophthalmol. https://doi.org/10.1007/s00417-020-04735-3, https://doi.org/10.1007/s00417-020-04735-3

  10. Rossi T, Querzoli G, Angelini G, Malvasi C, Iossa M, Placentino L, Ripandelli G (2014) Fluid dynamics of vitrectomy probes. Retina. 34:558–567. https://doi.org/10.1097/IAE.0b013e3182a0e628

    Article  PubMed  Google Scholar 

  11. Kang SW, Ahn K, Ham DI (2003) Types of macular hole closure and their clinical implications. Br J Ophthalmol 87:1015–1019

    Article  CAS  Google Scholar 

  12. Rossi T, Querzoli G, Angelini G et al (2014) Introducing new vitreous cutter blade shapes: a fluid dynamics study. Retina. 34:1896–1904. https://doi.org/10.1097/IAE.0000000000000143

    Article  PubMed  Google Scholar 

  13. Rossi T, Querzoli G, Gelso A et al (2017) Ocular perfusion pressure control during pars plana vitrectomy: testing a novel device. Graefes Arch Clin Exp Ophthalmol 255:2325–2330. https://doi.org/10.1007/s00417-017-3799-2

    Article  PubMed  Google Scholar 

  14. Imai M, Iijima H, Gotoh T, Tsukahara S (1999) Optical coherence tomography of successfully repaired idiopathic macular holes. Am J Ophthalmol 128:621–627

    Article  CAS  Google Scholar 

  15. Michalewska Z, Michalewski J, Cisiecki S, Adelman R, Nawrocki J (2008) Correlation between foveal structure and visual outcome following macular hole surgery: a spectral optical coherence tomography study. Graefes Arch Clin Exp Ophthalmol 246:823–830. https://doi.org/10.1007/s00417-007-0764-5

    Article  PubMed  Google Scholar 

  16. Mahmoud TH, McCuen BW 2nd (2007) Natural history of foveolar lucencies observed by optical coherence tomography after macular hole surgery. Retina. 27:95–100. https://doi.org/10.1097/01.iae.0000223758.17543.49

    Article  PubMed  Google Scholar 

  17. Zarranz-Ventura J, Ellabban AA, Sim DA, Keane PA, Kirkpatrick JN, Sallam AAB (2018) Prevalence of foveolar lucency with different gas tamponades in surgically closed macular holes assessed by spectral domain optical coherence tomography. Retina. 38:1699–1706. https://doi.org/10.1097/IAE.0000000000001762

    Article  PubMed  Google Scholar 

  18. Qi B, Yu Y, You Q et al (2020) Evolution and visual outcomes of outer foveolar lucency after surgery for large idiopathic macular hole [published online ahead of print, 2020 Jun 30]. Graefes Arch Clin Exp Ophthalmol. https://doi.org/10.1007/s00417-020-04814-5, https://doi.org/10.1007/s00417-020-04814-5

Download references

Acknowledgements

The authors would like to thank the Fondazione Roma for support.

Author information

Authors and Affiliations

  1. IRCCS Ospedale Policlinico San Martino – UOC Oculistica, Largo Rosanna Benzi 2, 16100, Genoa, Italy

    Tommaso Rossi & Serena Telani

  2. Ospedale Careggi, Florence, Italy

    Daniela Bacherini & Tomaso Caporossi

  3. Arcispedale Santa Maria Nuova, Reggio Emilia, Italy

    Danilo Iannetta

  4. Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy

    Stanislao Rizzo

  5. The Retina Partners, Los Angeles, CA, USA

    Stavros N. Moysidis & Nicole Koulisis

  6. USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Nicole Koulisis

  7. Associated Retinal Consultants, PC, Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA

    Tamer H. Mahmoud

  8. IRCCS Fondazione G.B. Bietti ONLUS, Rome, Italy

    Guido Ripandelli

Authors
  1. Tommaso Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniela Bacherini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomaso Caporossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Serena Telani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Danilo Iannetta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stanislao Rizzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stavros N. Moysidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nicole Koulisis
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tamer H. Mahmoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Guido Ripandelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

T. Rossi: manuscript writing and design study. D. Bacherini: data search, proof reading, and design study. T. Caporossi: data search and manuscript writing. S. Telani, N. Koujlisis, and T. Mahmoud: manuscript writing and proof reading. D. Iannetta, S. Rizzo, and G. Ripandelli: data search and proof reading. S. Moysidis: data search

Corresponding author

Correspondence to Tommaso Rossi.

Ethics declarations

Present research complies with the guidelines for human studies and was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. IRB approval was obtained, and informed consent was obtained by patients involved in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Disclaimer

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licencing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the topical collection on Macular Hole

Electronic supplementary material

ESM 1

(CSV 4 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rossi, T., Bacherini, D., Caporossi, T. et al. Macular hole closure patterns: an updated classification. Graefes Arch Clin Exp Ophthalmol 258, 2629–2638 (2020). https://doi.org/10.1007/s00417-020-04920-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04920-4

Keywords

Search

Navigation