Hole diameter ratio for prediction of anatomical outcomes in stage III or IV idiopathic macular holes
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RESEARCH ARTICLE
Open Access
Hole diameter ratio for prediction of anatomical outcomes in stage III or IV idiopathic macular holes Yue Qi1, Yanping Yu1, Qisheng You2, Zengyi Wang1, Jing Wang1 and Wu Liu1*
Abstract Background: To determine whether preoperative hole diameter ratio (HDR) is a predictive factor for postoperative anatomical outcome for stage III or IV idiopathic macular holes (IMHs). Methods: One-hundred and one eyes with stage III or IV IMH were included in this retrospective case series study. All cases were treated with vitrectomy combined with internal limiting membrane (ILM) peeling and room air tamponade. The macular hole (MH) minimum and maximum diameter was measured on preoperative optical coherence tomography (OCT) images. The HDR was defined as the minimum to maximum diameter ratio. Results: Eighty-one eyes (80.2%) got a Type I closure after surgery (group A). Postoperative unclosed MHs were found in 20 eyes (19.8%) (group B). The preoperative minimal diameter (703.6 ± 116.1 μm vs. 597.6 ± 120.1 μm, P < 0.01) and HDR (0.6 ± 0.1 vs. 0.5 ± 0.1, P = 0.01) were both significantly smaller in postoperative closed eyes. The closure rate of IMHs with HDR < 0.6 was significantly higher than those with HDR ≥ 0.6 (90.2% vs. 65.0%P = 0.002) . Conclusions: Preoperative HDR < 0.6 is predictive for a good postoperative anatomical outcome in stage III or IV IMHs. Keywords: Idiopathic macular hole, Predictive factor, Vitrectomy, Internal limiting membrane peeling, Optical coherence tomography
Background Idiopathic macular hole (IMH) is one of the most often causes of poor vision. The estimated incidence of IMH ranged from 0.3 to 0.8% in general population [1, 2]. It may cause a small dark spot in the central vision. MH may be related with high myopia or ocular trauma, but the reason of most MHs is unknown (idiopathic) [3]. Based on the optical coherence tomography (OCT) images of macular region, IMHs can be divided into 4 stages, stage III or IV MH was considered as refractory macular hole (MH) due to the low close rate after surgery [4]. * Correspondence: [email protected] 1 Beijing Tongren Eye Center, Beijing Ophthalmology and Visual Science Key Lab; Beijing Tongren Hospital, Capital Medical University, 1 Dongjiaomminxiang Street, Dongcheng District, Beijing 100730, China Full list of author information is available at the end of the article
Pars plana vitrectomy (PPV) is the most popular way to treat full-thickness MH at present [5]. The main indications to perform vitrectomy in eyes with MH are as following: stage II-IV MH; decreased visual acuity (0.05– 0.5) or/and visual distortion. Internal limiting membrane (ILM) peeling has been proved to increase the closure rates of IMHs [6]. It has been reported that more than 90% of IMHs closed after being treated with PPV combined with ILM peeling and inert gas or room air tamponade [7–10]. The initial closure rates of IMHs ranged from 75.6 to 100% [11–15]. However, there are still some IMHs cannot close after surgery, especially in stage III or IV IMHs. The
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