Defining a Cutoff for Progression of Macular Holes

Area of Science:

• Ophthalmology
• Retinal Imaging
• Macular Diseases

Background:

• Idiopathic full-thickness macular holes (MHs) can impact vision.
• Accurate assessment of MH size changes is crucial for treatment decisions.
• Differentiating true progression from measurement variability is clinically significant.

Purpose of the Study:

• To establish a reliable cutoff value for determining true enlargement of idiopathic macular hole (MH) size.
• To identify risk factors associated with changes in MH minimum linear diameter (MLD).
• To assess the impact of MH progression on best-corrected visual acuity (BCVA).

Main Methods:

• Retrospective analysis of 51 patients undergoing MH surgery.
• Optical coherence tomography (OCT) scans were used for MH size measurements at baseline and 4 weeks.
• A cutoff for MH size progression was determined using limits of agreement analysis.

Main Results:

• A cutoff of 31 µm was established to define true MH enlargement, independent of initial MH size.
• MH size progression occurred in 82.4% of patients with vitreomacular traction (VMT) versus 26.5% without (P < 0.001).
• Deterioration in BCVA was observed in patients with MH progression, while no significant change occurred in those without.

Conclusions:

• The 31 µm cutoff effectively differentiates true macular hole enlargement from measurement error.
• A significant proportion of MHs show progression within 4 weeks, particularly when VMT is present.
• This cutoff aids clinicians in managing MHs and understanding visual acuity outcomes.