Macular hole closure patterns: an updated classification
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Macular hole closure patterns: an updated classification Tommaso Rossi 1 & Daniela Bacherini 2 & Tomaso Caporossi 2 & Serena Telani 1 & Danilo Iannetta 3 & Stanislao Rizzo 4 & Stavros N. Moysidis 5 & Nicole Koulisis 5,6 & Tamer H. Mahmoud 7 & Guido Ripandelli 8 Received: 7 July 2020 / Revised: 25 August 2020 / Accepted: 2 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The classification of macular hole closure patterns (MHCPs) currently relies on time domain OCT allowing only “open” and “closed” statuses or is based on inner foveal contour shape. Both classification types give no information on retinal layer reconstitution. Novel sophisticated surgical techniques lead to previously unknown MHCPs, outdating existing classifications and urging new ones. The purpose of the present study is to introduce a new classification allowing proper description of all MHCPs resulting from newer surgeries and based on the restoration of retinal layers. Methods Retrospective analysis of patients undergoing MH surgery with five different surgical techniques was performed. MHCPs were classified according to spectral domain optical coherence tomography (SD-OCT). Type 0: open MH (0A: flat margin, 0B: elevated, 0C: oedematous); type 1: closed MHs (1A: reconstitution all retinal layers; 1B interruption of the external layers; 1C interruption of internal layers); type 2: MH closed with autologous or heterologous filling tissue interrupting the normal foveal layered anatomy (2A: filling tissue through all layers; 2B reconstitution of normal inner retinal layers; 2C reconstitution of normal outer retinal layers; 2D H-shaped bridging of filling tissue). Results Closure rate was 95.2% (241/253). Surgical technique and vision correlated to closure pattern (p < 0.001). Type 1 MHCPs had the best post-operative visual acuity (VA) compared with type 2 and type 0 (p < 0.001). MHCPs 1A and 1C performed better than all others. MHCP at months 1 and 3 changed in 42/254 (16.5%) and remained stable in 212/254 (83.5%). Improvement in vision was higher in eyes with shifting closure pattern (0.57 ± 0.33 vs 0.51 ± 0.48 logMAR; p 0.021). Conclusion MHCP classification based on retinal layer restoration properly comprises post-operative anatomic morphologies. MHCPs correlate the surgical technique and post-operative visual outcomes. Keywords Macular hole . Closure pattern . Pars plana vitrectomy . Internal limiting membrane . Human amniotic membrane . Autologous retinal transplantation . Graft . Amniotic membrane implant . Autologous retina implant
This article is part of the topical collection on Macular Hole Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00417-020-04920-4) contains supplementary material, which is available to authorized users. * Tommaso Rossi [email protected] 1
IRCCS Ospedale Policlinico San Martino – UOC Oculistica, Largo Rosanna Benzi 2, 16100 Genoa, Italy
2
Ospedale Careggi, Florence, Italy
3
Arcispedale Santa
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