Korean J Ophthalmol.  2010 Aug;24(4):213-218. 10.3341/kjo.2010.24.4.213.

Central Photoreceptor Viability and Prediction of Visual Outcome in Patients with Idiopathic Macular Holes

• Chung SE
• Lim DH
• Kang SW
• Yoon YH
• Chae JB
• Roh IH

• KMID: 949058
• DOI: http://doi.org/10.3341/kjo.2010.24.4.213

Abstract

PURPOSE
To identify the correlation between preoperative optical coherence tomography (OCT) features and postoperative visual outcomes in eyes with idiopathic macular holes (MHs).
METHODS
Data from 55 eyes with idiopathic MHs which had been sealed by vitrectomy were retrospectively reviewed. Correlation analysis was conducted between postoperative visual acuity (V(postop), logarithm of the minimum angle of resolution [logMAR]) and preoperative factors, including four OCT parameters: the anticipated length (A) devoid of photoreceptors after hole closure, MH height (B), MH size (C), and the grading (D) of the viability of detached photoreceptors. Additionally, the formula for the prediction of visual outcome was deduced.
RESULTS
V(postop) was determined to be significantly correlated with the preoperative visual acuity (V(preop)) and OCT parameters A, C, and D (p<0.001). Based on the correlation, the formula for the prediction of V(postop) was derived from the most accurate regression analysis: V(postop)=0.248xV(preop)+1.1x10(-6)xA(2)-0.121xD+0.19.
CONCLUSIONS
The length and viability of detached photoreceptors are significant preoperative OCT features for predicting visual prognosis. This suggests that, regardless of the MH size and symptom duration, active surgical intervention should be encouraged, particularly if the MH exhibits good viability in the detached photoreceptor layer.

Keyword

Optical coherence tomography; Photoreceptor; Visual acuity

MeSH Terms

Cell Survival
Female
Follow-Up Studies
Humans
Male
Middle Aged
Photoreceptor Cells, Vertebrate/*pathology
Prognosis
Retinal Perforations/*pathology/physiopathology/surgery
Retrospective Studies
Tomography, Optical Coherence
Visual Acuity/*physiology
Vitrectomy/methods

Figure

• 

  Fig. 1 Evaluated preoperative parameters in the optical coherence tomography image; calculated A refers to the anticipated length devoid of photoreceptors after closing the macular hole (MH). The length of α1, α2, and β are measured to calculate A. α1 and α2 are the curved lengths of the detached photoreceptors and β is the line length of the retinal pigment epithelial layer not in contact with the photoreceptors. MH height; B is the vertical length between the retinal pigment epithelial layer and the highest portion of the MH. MH diameter; C is determined at the minimal extent of the hole.

• 

  Fig. 2 Exemplary cases utilized for the grading of viability in detached photoreceptors (parameter D). Yellow dot lines indicate inner segment-outer segment junction of the photoreceptor layer; grade 2 (C,C') is assigned to tall and healthy-looking photoreceptors with fine and regular reflectivity (arrows), grade 0 (A,A') is assigned to short and irregular photoreceptors with coarse reflectivity (arrows), and grade 1 (B,B') lies in between the two grades or represents an ambiguous judgment on any one section of the vertical or horizontal scans.

• 

  Fig. 3 Visual acuity (VA, logarithm of the minimum angle of resolution [logMAR]) calculated from the predictive formula and actual postoperative VA in the 55 eyes (A), in the new group of 20 eyes (B), and in 20 eyes from another center (C).

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