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Angulation of the inner nuclear layer as an indicator of the severity of macular pseudohole

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

Abstract

Purpose

To investigate foveal morphologic parameters related to visual acuity and the stages classified in this study reflect the severity of the macular pseudohole (MPH).

Methods

Seventy-eight eyes of 78 consecutive patients diagnosed with MPH were studied. Quantitative optical coherence tomography (OCT) parameters including central foveal thickness, parafoveal thickness, parafoveal inner and outer retinal thickness (PIRT and PORT), pseudohole depth, pseudohole diameter, and inner nuclear layer (INL) angulation were measured and the morphologic features of the inner retina (disorganization of retinal inner layers (DRIL)) and the photoreceptor layer (external limiting membrane (ELM), ellipsoid zone (EZ), interdigitation zone (IZ), and cotton ball sign) were determined. Associations between OCT parameters and best-corrected visual acuity (BCVA) were analyzed. Based on the location of the inner margin of INL, all patients were divided into three stages and the mean comparison between the three stages was analyzed.

Results

PIRT (r = 0.6489; p < 0.0001) and pseudohole depth (r = 0.5266; p < 0.0001) had a statistically significant correlation with BCVA. Statistically significant visual acuity differences were found in eyes with DRIL (p < 0.001) and IZ disruption (p = 0.018), but not in ELM disruption (p = 0.916), EZ disruption (p = 0.581), and cotton ball sign (p = 0.075). According to the univariate and multivariate regression analyses, PIRT was associated with BCVA in both univariate (p < 0.001) and multivariate (p = 0.002) regression analyses. Defect diameters of both ELM (p = 0.025) and IZ (p = 0.006) were associated with BCVA in univariate regression analysis, but not in multivariate regression analysis.

INL angulation and the ratio of the IZ disruption was significantly different in the three groups. Stage 3 (95.8%) had significantly higher disrupted IZ ratio than stage 1 (40%) and stage 2 (65.5%). The BCVA of stages 1, 2, and 3 were identified as 0.06 ± 0.07 (20/23 Snellen equivalent), 0.23 ± 0.17 (20/34 Snellen equivalent), and 0.48 ± 0.23 (20/60 Snellen equivalent), respectively, and the differences in BCVA between the three groups were significant (p < 0.0001).

Conclusion

The parameters related to visual acuity were PIRT, pseudohole depth, DRIL, and IZ. The stage classification proposed in this study included morphologic changes of the inner retina and photoreceptor layer and is likely to be clinically useful for showing the severity of the MPH.

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Funding

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2016R1A6A1A03010528).

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Authors and Affiliations

  1. Kong Eye Hospital, Seoul, South Korea

    Hee Chan Ku, Eun Hyung Cho, Jeong Mo Han & Eun Koo Lee

  2. Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Young-Hoon Park

  3. Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Young-Hoon Park

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  1. Hee Chan Ku
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Correspondence to Young-Hoon Park.

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All authors have not published or submitted any related papers of the present study.

Conflict of interest

Young-Hoon Park was supported by grants from the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2016R1A6A1A03010528). The following authors have no financial disclosures: Hee Chan Ku, Eun Hyung Cho, Jeong Mo Han, and Eun Koo Lee.

Ethical approval

This study was approved by the Institutional Review Board of Kong Eye Hospital, and the research protocol adhered to the tenets of the 1964 Declaration of Helsinki and its later amendments. For this type of study, formal consent not was required.

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Ku, H.C., Cho, E.H., Han, J.M. et al. Angulation of the inner nuclear layer as an indicator of the severity of macular pseudohole. Graefes Arch Clin Exp Ophthalmol 259, 69–79 (2021). https://doi.org/10.1007/s00417-020-04822-5

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  • DOI: https://doi.org/10.1007/s00417-020-04822-5

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