Short-term progression of macular holes in patients awaiting surgery

Author: Saskia Hoffmann (Germany)

Co-authors: Ahmed Almarzooqi, Navid Johannigmann-Malek, Chris P Lohmann, Stephen B Kaye, Carmen Baumann

Purpose

To determine a cutoff for progression of macular hole (MH) size.

Setting/Venue

Ophthalmology Department, Hospital rechts der Isar, Technical University of Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany

Methods

Patients were included who were waiting for MH surgery. Two observers performed 3 repeat sets of MH size measurements on optical coherence tomography (OCT) high-density radial scans at baseline and at 4 weeks. Main outcomes were change in minimum linear diameter (MLD) size and best-corrected visual acuity (BCVA).

Results

Fifty-one patients were included. The cutoff for an increase in MLD size calculated as the outer confidence limit for the 99.73% limits of agreement was 31 µm. This was independent of MH size. Using this cutoff, MLD size increased in 9/34 (26.5%) of patients without and in 14/17 (82.4%) of patients with vitreomacular traction (VMT) (p<0.001). Mean BCVA deteriorated in patients in whom the MH had progressed from 0.62 (±0.23) logMAR (20/83 Snellen) to 0.82 (±0.29) (20/132 Snellen) (p<0.001), while there was no significant change in BCVA in patients without MH progression (p=0.25). In 31% (16/51) of patients, classification of their MHs changed over the 4 week period.

Conlusions

Using a cutoff discriminates change from measurement error. A significant proportion of MHs progressed by 4 weeks, particularly in the presence of VMT, accompanied by a deterioration in BCVA.

Financial Disclosure

No financial relations