Volumetric Optical Coherence Tomography Analysis of Visual and Surgical Outcomes in Patients With Full-Thickness...

Purpose: To investigate the relationship between preoperative volumetric optical coherence tomography (OCT) features of full-thickness macular holes (FTMHs), including intraretinal cysts and 3-dimensional hole symmetry, and both visual acuity outcomes and surgical prognosis in patients with FTMH. Methods: This multicenter, retrospective cohort study assessed patients with FTMH who underwent pars plana vitrectomy from 2017 to 2022. In-depth manual segmentation of each pre- and postoperative OCT volumetric scan (60 B-scans per volume) was performed by 3 graders. Correlations between preoperative cystoid volume and FTMH symmetry and preoperative visual acuity, preoperative minimum linear diameter (MLD), improvement in visual acuity at 6 months postsurgery, and FTMH closure rate postsurgery were assessed using linear regression models, adjusted for baseline lens status, duration of symptoms, and MLD. Results: A total of 69 eyes of 69 patients with FTMH were included. Mean (± SD) visual acuity was 0.69 ± 0.44 logMAR (Snellen 20/98) before surgery, and improved to 0.39 ± 0.23 logMAR at 6 months after surgery (Snellen 20/49). FTMH closure after a single surgery was 96%. Greater cystoid volume before surgery was associated with larger FTMH MLD (P < .001), worse preoperative visual acuity (P = .003), and greater visual acuity improvement at 6 months after surgery (P = .02). Greater hole asymmetry before surgery was associated with smaller MLD (P = .04), but not associated with preoperative visual acuity (P = .74) or postoperative FTMH closure rates (P = .19). Conclusions: This study on OCT volumetric measurements showed that intraretinal cystoid volume correlated with larger macular holes and greater visual acuity improvement while smaller macular holes tended to be more asymmetric.