Poster Satya Pal Raji

Background:

To evaluate the role of Optical Coherence Tomography guided hole form factor (HFF) in the surgical outcome for non-idiopathic full thickness macular holes.

Methods:

In this prospective interventional study 27 eyes of 27 subjects (24 males (88.9%) and 3 females (11.1%)) with mean age of 28.57 +20.155 (SD 16.54) Non – Idiopathic full thickness macular holes and no other confounding factors were enrolled.  Comprehensive ophthalmic examination including best-corrected visual acuity, fundus photography, and OCT was performed at baseline and post operatively. There was macular hole stage II (n = 1), stage III (n =(20), stage IV (n= 6) according to the classification by Gass were examined with optical coherence tomography (OCT) before and after surgery. Macular hole diameters were determined at the level of retinal pigment epithelium (base diameter), and at the minimal extent of the hole (minimum diameter). Based on the calculated hole form factor (HFF) patients were divided into two groups, HFF ≤0.6 and HFF ≥0.9. Calculated HFF was correlated with post-operative anatomical success rate and best-corrected visual acuity. All patients were subjected to Pars plana vitrectomy, ICG assisted ILM peeling and C3 F8 tamponade and prone position for 01 week. Patients were examined on the 1st post-operative day, 01 week, 6 weeks and 12 weeks after the procedure.

Results: 

15 patients were in Group I (HFF ≤0.6) and 12 patients belonged to Group II (HFF ≥0.9), with mean duration of symptoms of 5.81 months (range 2-18 months).  21 eyes (77.8%) had history of trauma, 4 had myopia (15%), 2 had macular hole secondary to CME (7%). Preoperative BCVA was – 1.185 (range – 0.6 to -2) by LogMAR units. The patients were followed up for an average period of 16.34 weeks (±5.93). There was statistically significant improvement in BCVA attained by Group II postoperatively. (Post-operative BCVA – 1.09 (SD 0.44) and -.76 (SD 0.29) in group I and Group II respectively) with p =0.038.  4 patients in group 1 (26.7%) 11 patients in group II (91.7%) had complete closure, with overall closure rate of 55.5%. Progression of nuclear sclerosis was seen in 11 eyes (40.7%), 9 eyes had elevation of IOP (33.3%) that could be managed medically and 1 patient had sterile endophthalmitis.

Conclusions:

This study concluded that HFF was a reliable predictor of surgical outcome in the treatment of Non- Idiopathic macular holes. The post-operative closure of non – idiopathic macular holes was related to macular HFF, which effectively measures tissue available for reapproximation and correlates with anatomical and functional outcome.  Higher HFF significantly correlated with a better anatomical outcome. Longer duration of presentation, less stringent inclusion criteria, various chorio- retinal changes and aetiopathogenesis play a major role in prognosis of non – idiopathic macular holes. Preoperative analysis and measurement of macular holes with OCT may help to delineate postoperative expectations for successful anatomical closure of the macular hole, visual acuity, and long-term closure.