DIFFERENCES IN ANATOMICAL AND VISUAL OUTCOMES AMONG THREE INTERNAL LIMITING MEMBRANE TECHNIQUES TREATING EXTRA-LARGE IDIOPATHIC MACULAR HOLES

VITRECTOMY COMBINED WITH INVERTED INTERNAL LIMITING MEMBRANE FLAP INSERTION OR SINGLE-LAYERED FLAP COVERING TECHNIQUE FOR HIGHLY MYOPIC MACULAR HOLES WITH MACULAR RETINOSCHISIS

PURPOSE

To investigate the anatomical and visual outcomes of inverted internal limiting membrane flap insertion versus single-layered i-internal limiting membrane flap covering in highly myopic macular holes associated with macular retinoschisis.

METHODS

A retrospective study compared 23 G vitrectomy with inverted-internal limiting membrane flap insertion (30 eyes) or covering (31 eyes) in highly myopic macular holes patients. Pre- and postoperative optical coherence tomography images and best-corrected visual acuity (BCVA) were evaluated. Macular hole schisis was classified into three types based on the extent of outer layer schisis. Regression analysis identified predictors of closure rate and postoperative BCVA.

RESULTS

The baseline data of the two groups were matched, including BCVA, axial length, and minimum linear diameter, except for a higher hole height in insertion group ( P = 0.038). After a mean follow-up of 11.7 months, type I closure rates were 83.3% (25/30) in the insertion group and 90.3% (28/31) in the covering group ( P = 0.335), respectively. The intact external limiting membrane in the covering group (7/28) was higher compared with the insertion group (1/28) finally ( P = 0.026). Final BCVA improved significantly in both groups ( P < 0.001); the BCVA was better in closed highly myopic macular holes in the covering group ( P = 0.011). Multivariate linear regression analysis revealed that preoperative BCVA (β = 0.386, P = 0.001) and Macular hole schisis stage (β = 0.309, P = 0.004) were independent predictive factors for the final BCVA.

CONCLUSION

The single-layered inverted-internal limiting membrane flap covering favored foveal structure recovery and provided a better visual prognosis in closed highly myopic macular holes compared with insertion. The preoperative BCVA and macular hole schisis stage were independent predictors of visual outcomes in patients with highly myopic macular holes.

Prediction of foveal microstructure and visual outcomes following surgery for idiopathic macular hole: An assessment using spectral-domain optical coherence tomography

PURPOSE

To evaluate the efficacy of two novel indices, the hole closure index (HCI) and the hole healing index (HHI), in predicting both the anatomic outcome and postoperative visual acuity following surgical intervention for idiopathic macular holes.

METHODS

A total of 38 patients diagnosed with idiopathic macular hole (IMH) were included. All patients underwent standard surgical treatment, including vitrectomy, internal limiting membrane (ILM) peeling, and gas tamponade. Preoperative and postoperative spectral-domain optical coherence tomography (SD-OCT) was utilized to assess the anatomical status of the macular hole (MH). The maximum distance between the tips of the external limiting membrane (ELM) was designated as the hole size (HS). HHI, calculated as the ratio of hole height to HS, and HCI, calculated as the ratio of hole height to the average of minimum diameter and base diameter, were determined. Postoperative reconstruction of ELM and ellipsoid zone (EZ) was evaluated, along with analysis of best-corrected visual acuity (BCVA) on a logarithm of the minimum angle of resolution (logMAR) scale. Regression analysis was performed to evaluate the relationship between anatomical outcomes, postoperative visual acuity, and optical coherence tomography (OCT) parameters. Receiver operating characteristic (ROC) curves were generated for both HHI and HCI.

RESULTS

Regression analyses revealed significant correlations between HCI and the restoration of ELM and EZ at 6 months after surgery (P = 0.002 and P = 0.014, respectively). In addition, a significant correlation was found between HHI and postoperative BCVA better than logMAR 0.52 also at 6 months after surgery (P = 0.033). The area under the ROC curve (AUC) for HCI based on ELM and EZ reconstruction was high, with values of 0.942 and 0.842, respectively. AUC for HHI, determined by ROC curve analysis of postoperative BCVA, was 0.704.

CONCLUSIONS

In conclusion, our findings indicate that HCI may be the most accurate predictor of type 1 closure, while HHI could be considered a potential predictor of postoperative visual acuity.