TY - JOUR
T1 - Morphologic Stages of Full-Thickness Macular Hole on Spectral-Domain OCT
AU - Pecaku, Aurora
AU - Melo, Isabela Martins
AU - Cao, Jessica A.
AU - Sabour, Shiva
AU - Naidu, Sumana C.
AU - Demian, Sueellen
AU - Popovic, Marko M.
AU - Wykoff, Charles C.
AU - Govetto, Andrea
AU - Muni, Rajeev H.
N1 - Publisher Copyright:
© 2024 American Academy of Ophthalmology
PY - 2024/10/24
Y1 - 2024/10/24
N2 - Objective: To describe the sequential morphological changes of the outer retina after full-thickness macular hole (FTMH) formation utilizing a novel, objective staging system based on OCT, and to determine its association with baseline visual acuity, duration of symptoms, and postoperative visual acuity at 3 months. Design: Retrospective, observational, multicenter study. Participants: Patients with idiopathic FTMH presenting to St. Michael's Hospital, Toronto, Canada, and Retina Consultants of Texas, Houston, Texas from 2009 to 2022. Methods: The medical charts of 1000 patients with FTMH were reviewed, and those with ≥2 preoperative spectral-domain OCTs (SD-OCTs) were analyzed. A staging system was developed by assessing outer retinal morphology on successive SD-OCT central foveal scans. Main Outcome Measures: Sequential outer retinal morphological changes with SD-OCT over time and their association with baseline visual acuity, duration of symptoms, and postoperative functional outcomes. Results: Fifty-two eyes of 52 patients with a mean age of 65.4 ± 8.4 years were included. Sequential outer retinal morphologic changes at the FTMH borders occurred in 4 distinct and reproducible stages: stage A, separation of the neurosensory retina from the retinal pigment epithelium with the well-defined external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (4/52, 7.7%); stage B, thickening of the EZ (27/52, 52.0%); stage C, patchy (moth-eaten) photoreceptor loss (16/52, 30.7%); and stage D, severe or complete loss of inner and outer segments and bare ELM (5/52, 9.6%). When assessing the preoperative OCT scans closest to the time of surgery, over a mean follow-up period of 288.9 ± 350.4 days (range, 5–1841), 28.85% (15/52) of eyes were in stage B, 28.85% (15/52) were in stage C, and 42.3% (22/52) were in stage D. There was a statistically significant association between increasing stage at baseline and longer duration of macular hole symptoms (P = 0.032) and worse visual acuity at baseline (P < 0.001). Additionally, patients presenting with stages B and C at the time point closest to surgery had better visual acuity outcomes 3 months postoperatively than those with stage D (P = 0.04). Conclusions: This SD-OCT staging system describes the sequential in vivo morphologic changes after FTMH formation, providing a novel imaging biomarker. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
AB - Objective: To describe the sequential morphological changes of the outer retina after full-thickness macular hole (FTMH) formation utilizing a novel, objective staging system based on OCT, and to determine its association with baseline visual acuity, duration of symptoms, and postoperative visual acuity at 3 months. Design: Retrospective, observational, multicenter study. Participants: Patients with idiopathic FTMH presenting to St. Michael's Hospital, Toronto, Canada, and Retina Consultants of Texas, Houston, Texas from 2009 to 2022. Methods: The medical charts of 1000 patients with FTMH were reviewed, and those with ≥2 preoperative spectral-domain OCTs (SD-OCTs) were analyzed. A staging system was developed by assessing outer retinal morphology on successive SD-OCT central foveal scans. Main Outcome Measures: Sequential outer retinal morphological changes with SD-OCT over time and their association with baseline visual acuity, duration of symptoms, and postoperative functional outcomes. Results: Fifty-two eyes of 52 patients with a mean age of 65.4 ± 8.4 years were included. Sequential outer retinal morphologic changes at the FTMH borders occurred in 4 distinct and reproducible stages: stage A, separation of the neurosensory retina from the retinal pigment epithelium with the well-defined external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (4/52, 7.7%); stage B, thickening of the EZ (27/52, 52.0%); stage C, patchy (moth-eaten) photoreceptor loss (16/52, 30.7%); and stage D, severe or complete loss of inner and outer segments and bare ELM (5/52, 9.6%). When assessing the preoperative OCT scans closest to the time of surgery, over a mean follow-up period of 288.9 ± 350.4 days (range, 5–1841), 28.85% (15/52) of eyes were in stage B, 28.85% (15/52) were in stage C, and 42.3% (22/52) were in stage D. There was a statistically significant association between increasing stage at baseline and longer duration of macular hole symptoms (P = 0.032) and worse visual acuity at baseline (P < 0.001). Additionally, patients presenting with stages B and C at the time point closest to surgery had better visual acuity outcomes 3 months postoperatively than those with stage D (P = 0.04). Conclusions: This SD-OCT staging system describes the sequential in vivo morphologic changes after FTMH formation, providing a novel imaging biomarker. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
KW - Full-thickness macular hole
KW - Morphologic changes
KW - Photoreceptors
KW - Spectral-domain OCT (SD-OCT)
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U2 - 10.1016/j.oret.2024.10.018
DO - 10.1016/j.oret.2024.10.018
M3 - Article
C2 - 39461424
AN - SCOPUS:85212311645
SN - 2468-6530
JO - Ophthalmology Retina
JF - Ophthalmology Retina
ER -