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The Importance of Anatomic Configuration and Cystic Changes in Macular Hole: Predicting Surgical Success with a
Yucel Ozturk1, Abdullah Ağın2, Nadir Kockar1
1Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey.
Purpose:
This study aimed to define a novel metric for the area of the macular hole (MH) and cysts located around the hole using an optical coherence tomography (OCT) device.
Methods:
This study was conducted with 58 eyes of 56 patients. The patients were divided into two groups according to anatomic closure after surgery. Using the metrics of macular hole index (MHI), tractional hole index (THI), hole forming factor (HFF), macular hole area (HA), the cystoid space areas in the inner retinal layers (CA), and our novel metric, the cyst hole area index (CHAI) was calculated. The correlation of the CA, the HA, and the CHAI with other indexes were assessed. Receiver operating characteristic (ROC) curves and cut-off values were derived for indexes predicting type 1 or type 2 closures.
Results:
The CA showed a strong positive correlation with the base MH size and the maximum MH height (r = 0.624, p < 0.001; r = 0.722, p < 0.001, respectively). The HA showed a strong positive correlation with basal MH size and minimum MH size (r = 0.934, p < 0.001; r = 0.765, p < 0.001). The HA showed a moderate positive correlation with maximum MH height (r = 0.483, p < 0.001, respectively). CHAI showed a moderate positive correlation with minimum MH size (r = 0.297, p = 0.02). CHAI and HA showed a moderate negative correlation with post-operative BCVA (r = -0.39, p = 0.003; r = -0.357, p = 0.006; respectively). ROC curve analysis showed that MHI (0.823), THI (0.750), and HFF (0.722) predicted type 1 closure and that CHAI (0.769) and HA (0.709) predicted type 2 closures.
Conclusion:
MHI and our novel index CHAI, which can be calculated without any additional software, could successfully predict type 1 and type 2 closures, respectively.
