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Inner segment/outer segment junction als prognostischer Faktor in der Makulachirurgie

Inner segment/Outer segment junction as prognostic factor in macular surgery

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Summary

PURPOSE: The aim of the study was to clarify whether an additional information about anatomical and functional prognosis can be made in different macular pathologies by means of high definition optical coherence tomography (OCT). METHOD: In this retrospective study all cases of surgical therapeutic interventions on the macula, conducted in KH Hietzing between July 2008 and July 2009, were analyzed regarding post operative visual acuity and course in OCT. Visual acuity and central retinal thickness in OCT were compared preoperatively to one month postoperative, as well as visual acuity after 3 months. 45 eyes were subdivided according to their pathology in: 19 eyes (42.2%) with epiretinal fibrosis (ERF), 8 (17.8%) with vitreomacular traction (VMT), 10 (22.2%) with full thickness macular hole (ML) and 8 (17.8%) with lamellar macular hole or pseudohole. RESULTS: All patients had a significant increase in visual acuity from 0.27 ± 0.17 Snellen to 0.42 ± 0.24 Snellen (p<0.001) 1 month postoperative. There was a significant reduction of central retinal thickness in the OCT, from 385.4 ± 94.6µm to 353.4 ± 66.5 µm (p = 0.015). Patients with ERF, who showed a continuous IS/OS-junction in the OCT at the last checkup, showed pre- and postoperatively better visual acuity (0.41 ± 0.20 vs. 0.27 ± 0.11, p = 0.084 and 0.58 ± 0.22 vs. 0.38 ± 0.15, p = 0.053). Furthermore, patients with VMT (0.52 ± 0.22 vs. 0.36 ± 0.18, p = 0.310) and patients with lamellar macular holes or pseudoholes (0.45 ± 0.07 vs. 0.66 ± 0.24, p = 0.137) tended to greater visual gain. Primary success in hole closure in patients with full thickness macular hole was associated with smaller diameter preoperatively (537.7 ± 246.7 µm vs. 984.3 ± 239.3 µm; p = 0.062). CONCLUSION: The postoperative course after macular surgery can be monitored more objectively and precisely with the help of high resolution OCT, whereby a more reliable prediction concerning visual acuity in relation with continuous IS/OS-junction can be made.

Zusammenfassung

PROBLEMSTELLUNG: Ziel der Studie war es zu klären, ob mittels hochauflösender optischer Kohärenztomografie (OCT) eine zusätzliche Aussage betreffend anatomischer und funktioneller Prognose bei verschiedenen Makulapathologien getroffen werden kann. METHODE: In dieser retrospektiven Studie wurden alle makulachirurgischen Eingriffe, die im KH Hietzing von Juli 2008 bis Juli 2009 durchgeführt wurden, hinsichtlich postoperativem Visusanstieg und Verlauf im OCT analysiert. Visus und zentrale Netzhautdicke im OCT präoperativ und 1 Monat postoperativ, sowie der Visus bei der Kontrolle nach durchschnittlich 3 Monaten wurden verglichen. 45 Augen wurden entsprechend ihrer Pathologie unterteilt in: 19 Augen (42,2%) mit epiretinaler Fibrose (ERF), 8 (17,8%) mit vitreomakulärer Traktion (VMT), 10 (22,2%) mit durchgreifendem Makulaloch (ML) und 8 (17,8%) mit lamellärem Makulaloch oder Pseudohole. ERGEBNISSE: Bei den insgesamt 45 PatientInnen kam es 1 Monat postoperativ zu einem signifikanten Visusanstieg von 0.27 ± 0,17 Snellen auf 0,42 ± 0.24 Snellen (p < 0,001) und zu einer signifikanten Abnahme der zentralen Netzhautdicke im OCT von 385,4 ± 94,6 µm auf 353,4 ± 66,5 µm (p = 0,015). Bei PatientInnen mit ERF, die bei der letzten Kontrolle eine durchgehende IS/OS-Junction im OCT aufwiesen, hatten sowohl präals auch postoperativ einen besseren Visus (0,41 ± 0,20 vs. 0,27 ± 0,11, p = 0,084 und 0,58 ± 0,22 vs. 0,38 ± 0,15, p = 0,053). Auch PatientInnen mit VMT wiesen einen tendenziell höheren Visusgewinn auf (0,52 ± 0,22 vs. 0,36 ± 0,18, p = 0,310) sowie PatientInnen mit lamellären ML und Pseudoholes (0,45 ± 0,07 vs. 0,66 ± 0,24, p = 0,137). PatientInnen mit durchgreifendem Makulaloch mit Lochschluss nach dem Ersteingriff (55,6%) hatten präoperativ einen kleineren Lochdurchmesser (537,7 ± 246,7 µm vs 984,3 ± 239,3 µm; p = 0,062). SCHLUSSFOLGERUNG: Mit Hilfe des hochauflösenden OCTs lässt sich der postoperative Verlauf nach Makulachirurgie objektiver und genauer kontrollieren, wodurch eine verlässlichere Aussage bezüglich der Visusprognose im Zusammenhang mit durchgehender IS/OS-Junction möglich wird.

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Authors and Affiliations

  1. Augenabteilung, KH Hietzing, Wien, Austria

    P. V. Vécsei-Marlovits, P. Irsigler & B. Weingessel

  2. Karl Landsteiner Institut für Prozessoptimierung und Qualitätsmanagement in der Kataraktchirurgie, Austria

    P. V. Vécsei-Marlovits, P. Irsigler & B. Weingessel

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  1. P. V. Vécsei-Marlovits
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  2. P. Irsigler
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Correspondence to P. V. Vécsei-Marlovits.

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Vécsei-Marlovits, P., Irsigler, P. & Weingessel, B. Inner segment/outer segment junction als prognostischer Faktor in der Makulachirurgie. Spektrum Augenheilkd. 24, 311–315 (2010). https://doi.org/10.1007/s00717-010-0447-1

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