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External limiting membrane angle as a composite predictive index for post-operative ELM closure in full thickness macular holes

  • Retinal Disorders
  • Published:
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Abstract

Aim

To evaluate pre-operative qualitative and quantitative parameters of external limiting membranes (ELM) and other associated full thickness macular holes (FTMH) features and their predictive values for post-operative anatomical and functional outcomes.

Methods

This was a retrospective study of 48 eyes that underwent vitrectomy with internal limiting membrane (ILM) peeling for FTMH and had type 1 closure. All subjects underwent optical coherence tomography (SDOCT, Heidelberg, Spectralis), and the eyes were divided into complete ELM closure (CEC) and incomplete ELM closure (IEC) groups based on the post-operative OCTs within 2 months, and ROC curves were used to estimate which of the pre-operative parameters could best predict eyes falling in the CEC group.

Results

The mean pre-op ELM defect was smaller in CEC group (594 μm vs 1126 μm, p < 0.001) and so was the pre-op EZ defect (770 μm vs 1186 μm, p = 0.001). The mean ELM angle also was smaller in the CEC group (51.6° vs 102.5°, p < 0.001) and so was the mean hole inlet distance (353 μm vs 596 μm, p < 0.001). The post-operative ELM defect showed a significant negative correlation with visual acuity (r = − 0.319; p = 0.027). The ELM angle was most predictive with an AUROC of 0.958, and a cut-off of 68.3° had a sensitivity of 90% and a specificity of 89%.

Conclusion

Our study introduces a novel parameter called the ELM angle and proves that it has a high sensitivity and specificity in predicting complete ELM reformation post-surgery in the short term as well as the long term.

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Acknowledgements

All contributors have been acknowledged as authors.

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Authors and Affiliations

  1. Department of Retina and Vitreous, Chaithanya Eye Hospital and Research Institute, Trivandrum, India

    Unnikrishnan Nair, Rahul R Menon, Ashwin Mohan, Asmita Indurkar & Manoj Soman

  2. Chaithanya Innovation in Technology and Eyecare (Research), Trivandrum, India

    Unnikrishnan Nair, Ashwin Mohan, Amritha Vijayan & Manoj Soman

Authors
  1. Unnikrishnan Nair
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  2. Rahul R Menon
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  3. Ashwin Mohan
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  5. Asmita Indurkar
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  6. Manoj Soman
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Correspondence to Ashwin Mohan.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Chaithanya Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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This article is part of a topical collection on Macular Holes

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Nair, U., Menon, R.R., Mohan, A. et al. External limiting membrane angle as a composite predictive index for post-operative ELM closure in full thickness macular holes. Graefes Arch Clin Exp Ophthalmol 258, 2603–2609 (2020). https://doi.org/10.1007/s00417-020-04949-5

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  • DOI: https://doi.org/10.1007/s00417-020-04949-5

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