Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis
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To assess the role of Spectral Domain Optical Coherence Tomography (SD-OCT) measurements as prognostic factors in myopic macular hole (MMH) surgery.
In a retrospective cohort study, we evaluated 42 eyes of 42 patients (Spherical equivalent > −6.00 D) who underwent pars plana vitrectomy with internal limiting membrane peeling for MMH without foveoschisis. Statistical analysis was performed to correlate postoperative best corrected visual acuity (BCVA) with preoperative BCVA, age, degree of myopia and seven preoperative OCT measurements: macular hole (MH) base, MH minimum diameter, MH height, Hole Form Factor (HFF), Macular Hole Index (MHI), Diameter Hole Index (DHI) and Tractional Hole Index (THI).
Primary and final anatomical success rate were 83.3 % (35/42) and 90.5 % (38/42), respectively. Four patients deferred reoperation and three underwent a second surgical approach to achieve MH closure. A posterior staphyloma was observed in 27 of 42 patients, and in three of them the MH was located in the apex of the staphyloma. Two of these three cases showed an open MH after the first surgery. Postoperative visual acuity improved in 22/42 (52.4 %) patients, worsened in 7/42 (16.7 %) and remained unchanged in 13/42 (30.9 %). Only MH minimum diameter (P = 0.03) and HFF (P = 0.02) correlated significantly with postoperative BCVA.
Minimum diameter and HFF are strongly correlated with postoperative visual outcomes in cases of MMH. Since analyzing MH configuration seems to improve the anatomical success rate after vitreous surgery in highly myopic patients, these parameters should be preoperatively evaluated by SD-OCT.
KeywordsHigh myopia Myopic macular hole Posterior staphyloma Optical coherence tomography Vitreoretinal surgery
We are greatly indebted to Giovanni Taibbi, Davide Ausili and Daniela Gilardi for their precious help in the statistical analysis.
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