External limiting membrane angle as a composite predictive index for post-operative ELM closure in full thickness macula
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External limiting membrane angle as a composite predictive index for post-operative ELM closure in full thickness macular holes Unnikrishnan Nair 1,2 & Rahul R Menon 1 & Ashwin Mohan 1,2
&
Amritha Vijayan 2 & Asmita Indurkar 1 & Manoj Soman 1,2
Received: 5 April 2020 / Revised: 10 August 2020 / Accepted: 18 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords External limiting membrane . Full thickness macular holes . ELM angle
Introduction Macular hole closure is attained by bridge formation, and the photoreceptors heal in varying degrees [1]. With improved visualization of fine retinal architectural features, ultrahighresolution optical coherence tomography (OCT) can visualize persistent retinal abnormalities despite anatomically successful macular hole surgery [2]. This article is part of a topical collection on Macular Holes * Ashwin Mohan [email protected] 1
Department of Retina and Vitreous, Chaithanya Eye Hospital and Research Institute, Trivandrum, India
2
Chaithanya Innovation in Technology and Eyecare (Research), Trivandrum, India
Spectral domain OCT can quantitatively measure photoreceptor IS-OS junction defects [3], and a good visual outcome has been correlated with an absence of these defects [4]. It has been reported that the visual outcomes are significantly better in eyes with a continuous inner segment/outer segment (ISOS) line than in those with a disrupted IS-OS line [1]. An increase in outer foveal th
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