Author: Paola L. Oquendo
Co-authors: Hesham Hamli, Afira Faleel, Thomas Wright, Flavia Nagel, Peng Yan, Rajeev H Muni
AbstractKey words: macular hole, adaptive optics, photoreceptors, cone density, vitrectomy.
The purpose of this study is to assess the photoreceptor mosaic in patients diagnosed with idiopathic macular hole (MH) before and after surgical repair using adaptive optics enhanced retinal imaging (AO).
This is a REB-approved, prospective case series, performed at Kensington Eye Institute. Subjects presenting with idiopathic MH treated with pars plana vitrectomy (PPV) between May and December 2021 were included. AO imaging was performed preoperatively and at 3 months after successful macular hole repair using the RTX1 camera (Imagine Eyes, Orsay, France). All images were manually assessed for quality and images without a clearly resolvable cone mosaic were excluded from the analysis. Cone density, packing regularity, and dispersion were measured at 2 and 4 degrees of eccentricity in all 4 quadrants (superior, inferior, nasal, and temporal) using the manufacturer’s software with manual correction. After correction for axial length, mixed effects modeling with repeated measures were used to identify significant changes.
8 patients (8 eyes) with idiopathic MH and with a successful surgical closure were analyzed. Mean cone density at 2° was 13407 mm3 preoperatively and 12154 mm3 postoperatively (95% CI= [-1227.77, 3734.21]); at 4°, cone density was 13542 mm3 preoperatively and 11807 mm3 postoperatively (95% CI= [892.68, 2577.80]). Mean regularity at 2° was 86.2% preoperatively and 83.6% postoperatively (95% CI= [-1.22, 6.57]); at 4°, was 87.7% preoperatively and 84.9% postoperatively (95% CI= [-3.04, 8.59]). Mean dispersion at 2° was 19.8% preoperatively and 22.6% postoperatively (95% CI= [-8.77, 3.22]); at 4°, was 20.09% preoperatively and 21.6% postoperatively (95% CI= [-4.83, 1.71]). There is no significant change to cone density (F(1,29) = 0.02, p =0.87), cone regularity (F(1,24) = 0.29, p =0.60) or cone dispersion (F(1,17) = 0.001, p =0.97) at either 2° or 4° eccentricity.
Adaptive optics imaging allows quantitative assessment of the photoreceptor mosaic before and after successful PPV in patients with idiopathic macular hole. This will enable further investigation of the photoreceptor remodeling process and microstructural changes following surgery.
No financial disclosure