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Morphologic Stages of Full-Thickness Macular Hole on Spectral-Domain OCT
Aurora Pecaku1, Isabela Martins Melo1, Jessica A Cao2
1Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
Objective:
To describe the sequential morphological changes of the outer retina after full-thickness macular hole (FTMH) formation utilizing a novel, objective staging system based on OCT, and to determine its association with baseline visual acuity, duration of symptoms, and postoperative visual acuity at 3 months.
Design:
Retrospective, observational, multicenter study.
Participants:
Patients with idiopathic FTMH presenting to St. Michael's Hospital, Toronto, Canada, and Retina Consultants of Texas, Houston, Texas from 2009 to 2022.
Methods:
The medical charts of 1000 patients with FTMH were reviewed, and those with ≥2 preoperative spectral-domain OCTs (SD-OCTs) were analyzed. A staging system was developed by assessing outer retinal morphology on successive SD-OCT central foveal scans.
Main Outcome Measures:
Sequential outer retinal morphological changes with SD-OCT over time and their association with baseline visual acuity, duration of symptoms, and postoperative functional outcomes.
Results:
Fifty-two eyes of 52 patients with a mean age of 65.4 ± 8.4 years were included. Sequential outer retinal morphologic changes at the FTMH borders occurred in 4 distinct and reproducible stages: stage A, separation of the neurosensory retina from the retinal pigment epithelium with the well-defined external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (4/52, 7.7%); stage B, thickening of the EZ (27/52, 52.0%); stage C, patchy (moth-eaten) photoreceptor loss (16/52, 30.7%); and stage D, severe or complete loss of inner and outer segments and bare ELM (5/52, 9.6%). When assessing the preoperative OCT scans closest to the time of surgery, over a mean follow-up period of 288.9 ± 350.4 days (range, 5-1841), 28.85% (15/52) of eyes were in stage B, 28.85% (15/52) were in stage C, and 42.3% (22/52) were in stage D. There was a statistically significant association between increasing stage at baseline and longer duration of macular hole symptoms (P = 0.032) and worse visual acuity at baseline (P < 0.001). Additionally, patients presenting with stages B and C at the time point closest to surgery had better visual acuity outcomes 3 months postoperatively than those with stage D (P = 0.04).
Conclusions:
This SD-OCT staging system describes the sequential in vivo morphologic changes after FTMH formation, providing a novel imaging biomarker.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
