Utilization of Spectral-Domain Optical Coherence Tomography Based Novel Staging and Closure Pattern Classification...

To investigate the clinical and prognostic relevance of spectral-domain optical coherence tomography (SD-OCT) based novel preoperative staging and postoperative closure pattern classification systems in the management of macular hole (MH).

A total 55 patients with idiopathic MH who underwent pars plana vitrectomy with internal limitan peeling surgery were evaluated for minimum linear diameter (MLD), basal hole diameter (BHD), MH edge heights, visual acuity and staging (defines the morphologic outer retinal changes) preoperatively, and postoperative visual acuity and MH closure patterns (MHCPs) (considering the retinal layer reconstitution) in this retrospective study.

MLD and BHD values were significantly higher in stage C (606.6 ± 161.1 µm and 1101.6 ± 289.1 µm, respectively, p < 0.05 for each) and stage D (691.5 ± 167.4 µm and 1271.0 ± 119.6 µm, respectively, p < 0.001 for each) than in stage A (381.1 ± 143.8 µm and 578.9 ± 143.3 µm, respectively). Visual acuity scores (postoperative 1^st, 3^rd and 6^th months) were worse in stage C (p < 0.001, p < 0.001 and p = 0.004, respectively) and stage D (p < 0.001for each) compared to stage A, and were better for type 1 A (p < 0.001 for each) and type 1 C (p = 0.010, p < 0.001 and p < 0.001) compared with type 0 closure, and for type 1 A vs. type 1B (p = 0.007 for 3^rd month and p = 0.012 for 6^th month). Type 0 closure was significantly more common in stage D than in stages A (87.5% vs. 0.0%, p < 0.01 for each) and B (87.5% vs. 13.3%, p < 0.001 for each), while type 1 A closure was more common in stage A (73.3%, p < 0.001) than in stages C (11.8%) and D (0.0%).

Our findings revealed clinically relevant associations between novel SD-OCT based preoperative morphological staging and postoperative MHCP classification systems in MH patients, supporting their potential utilization for clinical decision-making and predicting postoperative functional and anatomic prognoses in this setting.