iOCT in clinical use: Correlation of intraoperative morphology and postoperative visual outcome in patients with full thickness macular hole

Abstract

Background: Due to intraoperative optical coherence tomography (iOCT), observation of retinal morphological changes during surgery has become possible. Objective: To analyze the intraoperative morphology of full thickness macular holes (FTMH) and the correlation with the postoperative function, a retrospective, observational clinical study was performed analyzing 32 eyes of patients treated at the hospital of the technical university of Munich. Material and methods: Using iOCT in 32 eyes of 32 consecutive patients, the operative morphology was analyzed during surgery. These findings were then correlated with the postoperative visual outcome. Results: After posterior vitreous detachment (PVD) the macular hole index (MHI) decreased by −0.05 (p = 0.01) and the base diameter (BD) increased by +99.4 μm (SD = 197.8 μm; p = 0.04). Closure rate was 100% at the first visit after a mean time of 73 days and the postoperative best corrected visual acuity (BCVA) significantly improved (p < 0.05). There were significant correlations between intraoperative morphology and postoperative results indicating a relation between low MHI and better postoperative BCVA (SCC = 0.50; p = 0.02), large BD and better postoperative BCVA (SCC = 0.43; p = 0.05) and large aperture after PVD and higher improvement of BCVA (SCC = 0.44; p = 0.03). Conclusion: Flattening and broadening of the FTMH occurred as a result of reduction of vitreoretinal traction. The significant correlation between a large operative BD and improved BCVA reveals the importance of intraoperative retinal relaxation.