Macular hole formation in fellow eyes with a perifoveal posterior vitreous detachment of patients with a unilateral macular hole

Foveal morphology of normal fellow eyes of patients with unilateral macular hole

PURPOSE

To determine the morphology of the fovea in the ophthalmoscopically and tomographically normal fellow eyes of patients with unilateral idiopathic macular hole (MH) and to determine the association between the foveal morphological parameters and the foveal outer nuclear layer (ONL) thickness.

DESIGN

Retrospective observational study.

PARTICIPANTS

Two hundred three normal fellow eyes of patients with unilateral MH and 216 normal eyes of 216 healthy subjects.

METHODS

All eyes were examined by swept source optical coherence tomography (OCT). The built-in software measured the average retinal and choroidal thickness in the center and in the inner four subfields defined in the Early Treatment Diabetic Retinopathy Study. The total retinal thickness and the three retinal layers at the fovea and parafovea (0.25- and 0.5-mm nasal and temporal from fovea) and foveal floor width (FFW) were measured in the image of a horizontal scan passing through the center of the fovea. We defined the thickness between the internal limiting membrane and outer plexiform layer as the inner retinal thickness, and the thickness between the external limiting membrane and retinal pigment epithelium as the outer retinal thickness. Multiple regression analyses were performed with the age, sex, axial length, and the presence of a posterior vitreous detachment as the dependent variables.

MAIN OUTCOME MEASURES

OCT measurements and correlations between the foveal parameters and foveal ONL thickness.

RESULTS

The fellow eyes had a thinner central retinal subfield, thinner fovea, thinner ONL at all points except 0.5 mm nasal, significantly thicker outer retina at all points, and a wider FFW (P=.040 to P<.0001). The foveal ONL thickness was significantly and positively correlated with the central subfield retinal thickness and foveal thickness and negatively with the FFW (all P< .0001).

CONCLUSIONS

The thinner and deeper fovea and the thinner ONL of the fellow eyes of patients with a unilateral MH makes these eyes more susceptible to forming MH.

Optical coherence tomography features and risk of macular hole formation in the fellow eye

Background

To investigate the risk of primary macular hole (MH) in the fellow eye, and to evaluate baseline characteristics and optical coherence tomography (OCT) features that precede MH formation in the fellow eye.

Methods

A retrospective review of 229 patients treated for primary MH at Stavanger University Hospital, Norway, from January 2008 through December 2018. The patients were categorised into two groups according to subsequent development of MH in the fellow eye. The OCT findings of the two groups were compared, and associated risk factors for MH formation assessed.

Results

Twenty cases of bilateral MH were identified. The overall bilateral disease risk was 8.8% (95% CI, 5.8–13.2%). Two patients were previously operated in the fellow eye, six patients presented with bilateral MH, and 12 patients subsequently developed MH in the fellow eye. The risk of subsequent MH development was 5.7% (95% CI, 3.3–9.8%). Although the extent of posterior vitreous detachment (PVD) tended to be more progressed in the bilateral group compared with the unilateral group, the difference was not statistically significant. In the bilateral group, 41.7% had outer retinal defects vs 6.6% in the unilateral group (p = 0.001), and 33.3% in the bilateral group had intraretinal pseudocysts vs 10.2% in the unilateral group (p = 0.036, not significant after multiple testing correction).

Conclusion

Outer retinal defects and intraretinal pseudocysts are associated with an increased risk of MH formation in the fellow eye, and complete PVD indicates a decreased risk of MH formation.

DEVELOPMENT OF IDIOPATHIC MACULAR HOLE IN FELLOW EYES: Spectral Domain Optical Coherence Tomography Features

PURPOSE

To investigate the long-term incidence and risk factors of macular hole (MH) development in the fellow eyes of patients with unilateral idiopathic MH.

METHODS

The retrospective case-control study involved the fellow eyes of 215 consecutive patients with idiopathic MH. The patients were classified into two groups according to the presence or development of MH in the fellow eye. The spectral domain optical coherence tomography features and clinical characteristics of each group were compared.

RESULTS

Twelve (5.6%) patients presented with bilateral MH at the initial visit, whereas 20 (9.3%) initially unilateral patients developed MH in the fellow eye over a median interval of 44 months. Vitreomacular traction and inner foveal cyst were noted more frequently in the baseline spectral domain optical coherence tomography scans of fellow eyes of the bilateral group (P < 0.01). An outer foveal defect was found in five patients (35.7%) of the bilateral MH group (P < 0.01).

CONCLUSION

The incidence of MH in fellow eyes was approximately 10%. The presence of outer foveal defect, inner foveal cyst, and vitreomacular adhesion or traction on spectral domain optical coherence tomography in the fellow eye was the risk factor for MH.

Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome

Background

To investigate the ability of intraoperative optical coherence tomography (iOCT) during macular hole (MH) surgery to image different hole edge configurations and predict the restoration of retinal microstructure and visual outcomes.

Methods

This retrospective case series study included 53 MH patients. One eye each was assessed with iOCT during vitrectomy after internal limiting membrane (ILM) peeling. The MHs were categorized into three groups according to the morphology of the hole edge. The Hole-Door group had vertical pillars of tissue that projected into the vitreous cavity after ILM peeling. The Foveal Flap group had a preoperative foveal flap that adhered to the hole edge after ILM peeling, and the Negative group had neither a hole-door nor a foveal flap. At 6 months after surgery, the retinal microstructure restoration and visual outcomes were compared among the groups.

Results

All eyes had MH closure, and the postoperative best corrected visual acuity (BCVA) was significantly improved compared with the preoperative BCVA (P < 0.001). The Hole-Door group (n = 15) and Foveal Flap group (n = 14) had significantly better final visual acuity and postoperative restoration of the external limiting membrane (ELM) than the Negative group (n = 24) (P = 0.002, P = 0.012). For the group in which the MH diameter (MHD) was ≤400 μm (n = 25), there were no significant differences in ELM restoration, ellipsoid zone (EZ) restoration, or BCVA among the three groups (P = 0.516, P = 0.179, and P = 0.179 respectively). For the MHD > 400-μm group (n = 28, the Hole-Door group and Foveal Flap group had significantly better final visual acuity and restoration of ELM than the Negative group (P = 0.013, P = 0.005).

Conclusions

The novel use of iOCT during MH surgery confirmed the presence of hole edges configured as door-holes, foveal flaps, or neither. The data acquired by iOCT can provide useful predictive information for postoperative restoration of the retinal microstructure and visual outcome of MH, especially large ones.

Traumatic macular hole study: a multicenter comparative study between immediate vitrectomy and six-month observation for spontaneous closure

Background

Closure of traumatic macular hole (TMH) can be achieved spontaneously or by surgical intervention. Thus far, there exist no prospective comparative studies that have analyzed the difference between the two modalities. This study aimed to compare the anatomical and visual recovery of eyes with TMH following either an immediate vitrectomy or six-month observation.

Methods

This was a multicenter prospective comparative study. Eight centers participated in the study. Patient data from 40 eyes with a recent history of blunt ocular trauma and newly formed full-thickness TMH were recruited in this study. The participating patients selected between an early vitrectomy or a six-month observation after a doctor explained the potential benefits and risks of both strategies in an unbiased manner. Twenty-five patients underwent an immediate vitrectomy, and 15 patients received six-month observation. Patients were assessed by spectral-domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA).

Results

Closure rates were 66.7% for the observational group, and 100% for the surgical group (P=0.002). There were no vision-threatening ocular complications in both groups. For the observational group, the mean closure time was 2.5±1.6 months, and 80% of the hole closure occurred within 3 months; cystic edema on the edge of the hole at baseline was significantly more frequent in the non-closed subgroup than in the closed subgroup (P=0.03). There were no significant differences in the foveal microstructure and in the final visual outcome between the spontaneously closed cases and the surgically closed cases.

Conclusions

TMH had a moderately high incidence of spontaneous closure, but an immediate vitrectomy achieved an even higher closure rate. Vitrectomy was effective and safe to treat TMH, while a 3-month observation for spontaneous closure may be an alternative modality for TMH management. Cystic edema on the edge of the hole may be an unfavorable factor for the spontaneous closure of TMH.

Pathogenesis and Management of Macular Hole: Review of Current Advances

Macular hole has been believed to be a disorder of vitreomacular interface, which forms as a result of abnormal vitreous traction from incomplete vitreous detachment. However, our recent studies demonstrated that dynamic forces, caused by mobile posterior cortical vitreous with fluid currents, exist already at early stages of macular hole development. Therefore, in eyes with flexible vitreous, the contributions of tractional forces due to vitreous shrinkage are unlikely. These facts indicate that in the development of idiopathic macular holes, there is a greater contribution of dynamic forces than has been previously reported. This review also evaluates the recent findings in the assessment of the idiopathic macular holes and the recent therapeutic strategies for optimal management. Inner limiting membrane is considered to improve anatomical closure rate; however, it is still questionable if peeling is necessary in holes less than 250 µm. There are plenty of publications indicating that in the management of small and medium size hole (less than 400 µm), use of long-lasting gas and face-down position is not always required; however, it may be necessary for the treatment of large holes. Ocriplasmin and expansile gas had been reported to be successful for management of small- and medium-sized holes and vitreomacular attachment.

Incidence of Macular Holes in the Fellow Eye without Vitreomacular Detachment at Baseline

PURPOSE

To determine the rate of macular holes (MH) occurring in the fellow eyes of eyes with MH depending on the vitreomacular interface at baseline.

METHODS

This was a retrospective study of patients operated on for idiopathic MH, with persistent vitreofoveal attachment in the fellow eye assessed by spectral-domain optical coherence tomography (SD-OCT). Follow-up lasted 6 months or more, and the main outcome was the occurrence of an MH.

RESULTS

The 77 fellow eyes included had a mean follow-up of 34.11 ± 22.3 months (6-78.4). At baseline, 31 eyes had vitreomacular traction (VMT), 35 vitreomacular adhesion, and 11 no posterior vitreous detachment. MH occurred in 19.5% of the cases (15/77). The rate of MH was significantly higher among the eyes with VMT than among the eyes without VMT at baseline (35.5 vs. 8.7%; p = 0.009).

CONCLUSION

One-third of eyes with VMT at baseline identified by SD-OCT will develop an MH in the following 5 years.

PRESERVATION OF THE FOVEAL FLAP IN MACULAR HOLE SURGERY

PURPOSE

To investigate the impact of preserving the foveal flap on surgical outcomes of full-thickness macular hole (MH) with foveal flaps.

METHODS

We retrospectively reviewed patients with Stages 2 and 3 idiopathic MH, who underwent pars plana vitrectomy by a single surgeon at Asan Medical Center from November 2011 to November 2016. In the study group, we included eyes with MH and a foveal flap on preoperative spectral domain optical coherence tomography and successfully preserved the flap during surgery. The control group included eyes with MH and an operculum in the posterior vitreous plane on preoperative optical coherence tomography. We compared the anatomical and functional surgical outcomes between these groups.

RESULTS

Postoperative mean best-corrected visual acuity at the last visit was 20/25 and 20/33 in the study (9 eyes) and control (23 eyes) groups, respectively. The study group showed a significantly better postoperative best-corrected visual acuity (P < 0.05). Restoration of both the external limiting membrane and ellipsoid zone, as assessed by spectral domain optical coherence tomography, was achieved in 9 (100%) and 15 (65.2%) eyes of the study and control groups, respectively.

CONCLUSION

Preserving the foveal flap might improve both functional and anatomical outcomes of vitrectomy for MHs with a foveal flap.

Idiopathic macular holes and direction of vitreomacular traction: structural changes and surgical outcomes

PurposeTo compare the structural changes, clinical course, and treatment outcomes of vertical and horizontal vitreomacular traction (VMT) induced impending macular holes (IMHs) and full-thickness macular holes (FTMHs).MethodsIn this retrospective study, 23 and 32 cases of IMHs and FTMHs, respectively, were analyzed. The IMH cases were divided into two subgroups: IMH with and without foveal detachment. Vitreofoveal traction angles (TAs) between the inner retinal surface and posterior hyaloid were measured from horizontal and vertical optical coherence tomography (OCT) images by using the trigonometric function (the angle equals the arctangent of the height over the base) after adjustments for magnification factors. The largest angle was defined as the vitreomacular TA for the examined case. The critical angle-the TA differentiating cases with (vertical traction) or without (horizontal traction) foveal detachment (vertical traction)-was determined using regression analysis. Pretreatment and posttreatment OCT images, clinical courses, and treatment outcomes were compared between the two groups.ResultsThe critical angle was 27.2°. Cases of vertical traction had higher foveal height in the IMH group and wider bases in the FTMH group (P<0.05 respectively). IMHs with vertical traction had greater VM attachment than those with horizontal traction. In the FTMH group, postoperative visual improvement was lower (P=0.002); in the vertical traction group, inner segment:outer segment defects persisted longer (P=0.02).ConclusionsThe critical angle separating vertical from horizontal traction was 27.2°. Vertical VMT results in greater foveal structural changes in IMHs and possibly less favorable surgical outcomes in FTMHs.

Optimal management of idiopathic macular holes

This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs), including vitrectomy, ocriplasmin (OCP), and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA), vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM), the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm), it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm) and chronic holes (>1-year history) are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with intravitreal OCP and its potential complications. Expansile gas can be considered as a further option in small holes with VMA; however, larger studies are required to provide guidance on its use.

RECOVERY OF FOVEAL PHOTORECEPTOR INTEGRITY AFTER VITRECTOMY IN EYES WITH AN IMPENDING MACULAR HOLE WITH VITREOMACULAR TRACTION SYNDROME

PURPOSE

To identify factors associated with the recovery of foveal photoreceptor disruption in eyes with an impending macular hole (MH) with vitreomacular traction syndrome after surgery.

METHODS

This study comprised 33 consecutive patients who underwent vitrectomy for Stage 1 impending macular hole with disrupted photoreceptor inner segment/outer segment (IS/OS) layer and were followed up for a minimum of 1 year after surgery. Preoperative optical coherence tomography (OCT) parameters were compared between eyes that achieved complete restoration of the IS/OS layer (Group A) and those that did not (Group B). Postoperative serial changes in best-corrected visual acuity (BCVA) and IS/OS disrupted length were also investigated.

RESULTS

Smooth and symmetric foveolar contour was restored in 29 eyes (87.9%). Complete recovery of IS/OS disruption was observed in 11 of 33 cases (33.3%, Group A). Group A exhibited a larger percentage of foveal pseudocysts (54.5% vs. 13.6%, P = 0.033) and a smaller mean aperture size (102.1 ± 182.1 μm vs. 241.5 ± 163.8 μm, P = 0.031) than Group B. Postoperatively, Group A revealed a significantly better visual outcome than Group Be, which was the same as Group B, but with the four eyes that developed a full-thickness macular hole excluded.

CONCLUSION

Restoration of the foveal photoreceptor layer was more likely to occur in eyes with a foveal pseudocyst and smaller aperture size.

Natural course of vitreomacular traction syndrome observed by spectral-domain optical coherence tomography

OBJECTIVE

Our study aimed to characterize the natural course of vitreomacular traction (VMT) syndrome, on which discrepancies have been reported in previous publications, by spectral-domain optical coherence tomography (SD-OCT).

DESIGN

Retrospective chart review.

PARTICIPANTS

A total of 23 eyes of 23 patients with idiopathic symptomatic VMT syndrome diagnosed and followed up in Peking Union Medical College Hospital from 2008 to 2013.

METHODS

Clinical records of all patients who underwent SD-OCT examination and were diagnosed and followed up as idiopathic VMT syndrome were reviewed. Those who had at least 2 visits were included. The median observation period of the patients was 8.2 ± 7.9 months.

RESULTS

The 23 eyes were categorized into 3 groups based on the follow-up results of SD-OCT: the posterior vitreous detachment (PVD) group comprised 4 eyes that developed complete PVD, the full-thickness macular hole (FMH) group included 4 eyes that formed FMH, and the persisted VMT (PVMT) group comprised the other 15 eyes with PVMT. Epiretinal membrane (ERM) persisted in all 5 eyes in the PVMT group. FMH occurred in 3 of 7 eyes with outer lamellar macular hole (LMH) at the first visit.

CONCLUSIONS

Spontaneous development of complete PVD in VMT syndrome during follow-up appeared to be more common in our study than in previous reports without SD-OCT. Persistence of ERM might be an unfavourable prognostic factor in the natural course of VMT syndrome. The outer LMH might be a risk factor for FMH formation.

MACULAR HOLE FORMATION AFTER VITREOMACULAR DETACHMENT WITH AN OPERCULUM

PURPOSE

To report the detailed changes in the macular morphology documented by spectral domain optical coherence tomography in a 74-year-old woman with macular hole (MH) formation after vitreomacular detachment with an operculum.

METHODS

History and clinical examinations included slit-lamp biomicroscopy, best-corrected visual acuity, color fundus photography, and spectral domain optical coherence tomography.

RESULTS

The patient was referred for decreased vision in the left eye (visual acuity, right eye, 20/20; left eye, 20/50). Spectral domain optical coherence tomography showed a full-thickness MH in the left eye. The right eye had a lamellar MH, and the photoreceptor inner/outer segment line was uninterrupted beneath the central fovea. The right eye had vitreomacular detachment with a small round operculum suggestive of an elevated inner foveal retina. Thirty-seven months after the initial visit, the patient returned with visual acuity in the right eye that had decreased to 20/50 and a full-thickness MH had developed in the presence of vitreomacular detachment. An epiretinal membrane appeared nasal to the fovea, and the macular surface had a triangular dimple beneath the membrane. A large retinal schisis developed nasal to the hole. A tightrope-like structure bridged the MH edges.

CONCLUSION

In this case, the MH resulted from the tangential traction caused by the epiretinal membrane after vitreomacular detachment developed; the MH was accompanied by a small round operculum, a retinal dimple beneath the membrane, and a tightrope-like structure that bridged the hole edges. The operculum likely comprised a detached inner foveal retina alone and did not include retinal photoreceptor cells.

Posterior vitreous mobility delineated by tracking of optical coherence tomography images in eyes with idiopathic macular holes

PURPOSE

To demonstrate the posterior vitreous mobility following eye movements in patients forming macular holes, using an optical coherence tomography (OCT) eye-tracking system.

DESIGN

Prospective consecutive interventional case series.

METHODS

Twenty-four eyes of 17 consecutive patients with idiopathic macular hole and the remaining fellow eyes were recruited. Following acquisition of baseline fundus scans, all patients were instructed to perform sets of standardized full-excursion vertical and horizontal eye movements. Immediately after each set of movements an OCT scan registered to the baseline fundus image was obtained using the eye-tracking system. Three images were then overlaid using picture-editing software, thereby documenting the changing configuration of the posterior vitreous as well as its position relative to the static retinal structures.

RESULTS

In patients with macular hole, 22 of 24 eyes (92%) had duplication of the posterior cortical vitreous in overlaid images. The extent of duplication (indicating mobility) was increased with increasing vitreous separation and as the stage of macular hole increased (75% in stage 0; 80% in stage 1; 100% in both stage 2 and stage 3). In all eyes in which there was a wavy configuration to the vitreous face, or in which there was a greater angle of vitreous insertion into the peripheral retina, vitreous mobility was evident on overlaid images (P = 2.7 × 10(-17) and P = 1.7 × 10(-13), respectively).

CONCLUSION

By dynamically evaluating patients, we offer potential mechanistic insights that may further implicate mobile vitreous and associated fluid currents in the pathogenesis and progression of macular holes.

Wider retinal artery trajectories in eyes with macular hole than in fellow eyes of patients with unilateral idiopathic macular hole

Purpose

To determine whether the width of the retinal artery (RA) trajectory was associated with the presence of a macular hole (MH).

Methods

A retrospective cross sectional case-control study was performed. The fundus photographs were rotated 90 degrees, and the coordinates of the best fit curve of the RA trajectory were determined automatically based on these plots using the ImageJ program. The converted coordinates were fit to a second degree polynomial (ax²/100 + bx + c) equation. The width and steepness of the RA trajectory, “a”, of the eyes with a MH eye were compared to that of the fellow eyes.

Results

One hundred and ten eyes of 55 consecutive patients (30 women) with a unilateral MH and healthy fellow eyes were analyzed. The mean age was 64.9 years (range 47-81 years). The constant ‘a’ was significantly smaller in eyes with a MH than that of the fellow eyes (0.379 ± 0.094 vs 0.416 ± 0.121, P = 0.001, paired t test), indicating that the RA trajectory was wider in the MH eyes than in the fellow eyes. There was a significant correlation between the axial length and ‘a’ of the RA trajectory in the MH eyes (R = 0.273, P = 0.044) and in the fellow eyes (R = 0.356, P = 0.008; Spearman’s rank correlation coefficient).

Conclusions

Because eyes with a MH have a significantly wider and flatter RA trajectory, there may be greater traction on the fovea which is located between the RA arches. The causative role of this finding is still unclear.

Long-term observation of the vitreomacular relationship in normal fellow eyes of patients with unilateral idiopathic macular holes

PURPOSE

To describe long-term changes in the vitreomacular relationship in normal fellow eyes of patients with unilateral idiopathic macular holes (MHs).

METHODS

This is a retrospective, observational case series. The medical records of patients who underwent surgery for idiopathic MHs between May 2000 and December 2010 were reviewed. Patients who had clinically normal fellow eyes and underwent 12 months or more of follow-up were included. The vitreomacular relationship in the fellow eyes was evaluated using optical coherence tomography (OCT) and slit-lamp biomicroscopy.

RESULTS

The study included 153 patients with a mean age of 65.5 years and a mean follow-up of 33.5 months (range, 12-121). The incidence of vitreomacular attachments evaluated by OCT was 52% (80 eyes) at initial examination, which decreased to 41, 37 and 23% at 1, 2 and 3 years after the initial examination, respectively. Of the 80 eyes with vitreomacular attachments at initial examination, 40 (50%) still had vitreomacular attachments at the final visit. Of the remaining 40 eyes in which vitreomacular separation occurred during follow-up, 11 (28%) developed an MH, with a mean interval of 45 months. None of the eyes with vitreomacular separation at presentation developed an MH.

CONCLUSION

This largest series of fellow eyes of MHs followed by OCT shows that, at presentation, about half of the patients already have premacular vitreous detachment and therefore no risk of MH, and that second MH develops in about 30% in the process of vitreomacular separation, which evolves over a prolonged period.

Vitreo-retinal interface changes on optical coherence tomography in the fellow eyes of patients with macular hole

AIM

To study the vitreo-retinal interface and macular changes on optical coherence tomography (OCT) in the fellow eyes of patients with macular hole.

METHODS

Patients with idiopathic macular hole in one or both eyes presented to our institute between January 2003 and December 2009 were evaluated retrospectively. Demographic details, best-corrected visual acuity and vitreo-retinal interface, and macular changes of the fellow eye on OCT were studied.

RESULTS

Seventy patients underwent OCT of both eyes during the study period. The average age group was 61.96 years and 35 (50%) were females. Among the fellow eyes, normal foveal contour was noted in 36 (51.4%) eyes and 34 (48.6%) eyes were observed to have vitreo-retinal interface changes. Of them, 13 (18.6%) eyes had some stage of full thickness macular hole and 21 (30.0%) eyes had interface changes. There was no statistical correlation between involved eye lesions (P=0.64) or visual acuity (P=0.55) as predictors of development of either fellow eye lesions or poor visual acuity.

CONCLUSION

There is a significant chance of having vitreo-retinal interface findings in the fellow eyes of patients presenting with macular hole. OCT should be considered in both eyes of patients with macular hole to detect early changes in the fellow eyes, which may require an early intervention.

Foveal thickness in healthy fellow eyes of patients with unilateral macular holes

PURPOSE

To compare the morphologic parameters of ophthalmoscopically and tomographically normal foveae of the fellow eyes of patients with a unilateral macular hole (MH), other unilateral retinal diseases, and healthy eyes.

DESIGN

Observational, cross-sectional study.

METHODS

Of the 849 subjects studied, 183 eyes were excluded because they had an abnormal vitreofoveal interface that might have affected the foveal thickness. The average regional retinal thicknesses of the Early Treatment Diabetic Retinopathy Study sectors determined by spectral-domain optical coherence tomography were compared among 160 patients with MH, 175 patients with epiretinal membrane, 145 patients with retinal vein occlusion, and 186 healthy subjects. The foveal depression was quantified as the foveal pit depth divided by the foveal pit diameter.

RESULTS

The fovea (1 mm) and central fovea were significantly thinner in the MH group (243 and 192 μm) than in the other groups (P < .0001). There were no significant differences in the thickness of the fovea and central fovea among the eyes with epiretinal membrane (254 and 203 μm) or retinal vein occlusion (251 and 202 μm) or in the healthy group (254 and 201 μm). The foveal depression was significantly greater in the MH group (0.063) than in the retinal vein occlusion group (0.059) or in the healthy group (0.058; P = .014 and P = .0014, respectively). Multiple regression analyses showed that a thinner fovea and a deeper foveal depression were associated significantly with the presence of MH (P = .0054 to P < .0001).

CONCLUSIONS

These results suggest that patients with MH have unique foveal morphologic features that predispose them to MH development.

Idiopathic full-thickness macular holes and the vitreomacular interface: a high-resolution spectral-domain optical coherence tomography study

PURPOSE

To analyze the vitreomacular interface in idiopathic full-thickness macular holes (MHs) using spectral-domain optical coherence tomography.

DESIGN

Prospective cross-sectional case series.

METHODS

Ninety-one eyes of 86 consecutive patients with a MH were examined by spectral-domain optical coherence tomography. The vitreomacular interface was assessed and the presence or absence of an operculum was analyzed.

RESULTS

Fifty-two eyes had a stage 2 MH, 12 eyes a stage 3 MH, and 27 eyes a stage 4 MH. No posterior hyaloid membrane was detected in any eyes with a stage 4 MH. In 35 (54.7%) of the 64 eyes with an MH without a complete posterior vitreous detachment (PVD), we saw a perifoveal PVD with vitreofoveal adhesion and partial dehiscence of the raised inner retina with an outer retinal separation in the MHs. In 24 (37.5%) of the 64 eyes without a complete PVD, an operculum, which is a hyperreflective structure of the foveal retina, was in front of the MH. The posterior hyaloid membrane was separated completely but adhered to the optic disc. In 2 (3.1%) of the 64 eyes without a complete PVD, the posterior hyaloid membrane was separated from the macula without an operculum. In 3 (4.7%) of the 64 eyes without a complete PVD, vitreofoveal adhesion on both edges of the hole was connected to the taut posterior hyaloid membrane without an operculum.

CONCLUSIONS

The vitreomacular interface had 4 configurations in MHs without a complete PVD. Approximately 55% of cases with an open roof in the eyes without a complete PVD may be at risk for progression to operculum formation (loss of retinal tissue).

Montage images of spectral-domain optical coherence tomography in eyes with idiopathic macular holes

PURPOSE

To describe the morphologic and anatomic relationships at the vitreoretinal interface, from the macula into the periphery, in patients with idiopathic macular hole. Montaged images of posterior and peripheral spectral-domain (SD) optical coherence tomography (OCT) studies were used to describe the anatomic vitreoretinal relationships.

DESIGN

Prospective, consecutive, observational case series.

PARTICIPANTS

Forty-six eyes of thirty-six consecutive patients with idiopathic macular hole and their fellow eyes.

METHODS

Montage images of 4 radial OCT scans (horizontal, vertical, and 2 oblique scans) through the fovea were obtained in each case.

MAIN OUTCOME MEASURES

Montage SD OCT images.

RESULTS

In fellow eyes, potential precursor changes to macular hole revealed shallow perifoveal vitreous separation that extends peripherally toward the equator. Two distinct configurations were noted at the posterior vitreous face; eyes without holes had a smooth curvature, whereas eyes with holes were more likely to have wavy, folded, or scalloped vitreous surfaces. At the onset of separation, most posterior vitreous cortex had a smooth curvature, but posterior vitreous folds increased with progressive separation. Also notable were zones of double-layered retinoschisis in regions of adherent posterior vitreous. Resulting granular hyperreflection in the peripheral vitreous was detectable in 50% to 60% of stage 1 or 2 holes but in only 33% of stage 3 or 4 holes.

CONCLUSIONS

The SD OCT montages taken at serial stages of idiopathic macular holes document distinct configurations of the posterior vitreous face, granular hyperreflection in the peripheral vitreous, and areas of peripheral retinoschisis. Montaging SD OCT images provides novel cross-sectional images of the vitreoretinal interface that may have broader application.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Prevalence of early and late stages of physiologic PVD in emmetropic elderly population

PURPOSE

To investigate the early and late stages of posterior vitreous detachment (PVD) in the foveal area in correlation with age and gender.

METHODS

Three hundred and thirty-five emmetropic eyes of 271 Caucasian patients (216 women/119 men) were examined by optical coherence tomography (OCT) and ultrasound (US). Eyes were classified into groups according to the patients age (up to 69.9; 70-74.9; 75-79.9; over 80 years) and to the clinical findings [Vitreous state: Detached in US; Detached in OCT; Foveal adhesion (FA); Attached vitreous].

RESULTS

The mean age was 76 ± 8 ranging from 44 to 89 years in female and 72 ± 10 ranging from 46 to 87 years in male subjects. The vitreous was attached in 32% of all eyes, 18.5% had FA, 18.5% were detached in OCT and 68% were detached in US. While prevalence of FA decreases with increasing age, OCT-diagnosed detachments did not change significantly with age. Between the ages of 70 and 75, an increase in PVD rates occurred. The prevalence of PVD was similar in both genders. Women were significantly older than men in the late-stage PVD in the eyes.

CONCLUSION

The use of OCT and US enabled us to detect a partial or total PVD in 80% of the eyes. A sudden increase in late-stage PVD between the ages of 70 and 75 was observed, correlating with the reported age prevalence of various macular diseases. In contrast to myopics, both genders of elderly emmetropics have a similar prevalence of PVD.