Full-Thickness Macular Hole Formation after Internal Limiting Membrane Peeling: Beware the "Omega Sign"

Area of Science:

• Ophthalmology
• Retinal Imaging
• Surgical Decision Making

Background:

• Internal limiting membrane (ILM) peeling is a common surgical procedure for various macular pathologies.
• Identifying preoperative risk factors for complications like full-thickness macular hole (FTMH) formation is crucial for surgical planning.

Purpose of the Study:

• To describe a novel clinical sign observed on spectral domain optical coherence tomography (SDOCT).
• To evaluate if this sign is associated with an increased risk of developing FTMH after ILM peeling.

Main Methods:

• Retrospective analysis of preoperative SDOCT images from two patients who developed FTMH post-ILM peeling.
• Identification of a specific preoperative SDOCT finding characterized by an "omega-" shaped configuration.

Main Results:

• Both patients exhibited a thin bridge of tissue on either side of the foveal center with an outer retinal defect on preoperative SDOCT.
• Photoreceptor displacement created a distinctive "omega-" shaped configuration in the preoperative SDOCT images.

Conclusions:

• The "omega-" shaped configuration on SDOCT may serve as a predictive indicator for FTMH development after ILM peeling.
• Vitreoretinal surgeons should consider this SDOCT sign when assessing surgical risks and making treatment decisions.