Assessment of Macular Hole Closure Speed Using Trans-tamponade OCT and 3-Dimensional Macular Hole Segmentation in the DISCOVER Study

Overview

Journal J Vitreoretin Dis

Publisher Sage Publications

Date 2024 Sep 25

PMID 39318985

Authors

Yavuz Cakir

Antoine Sassine

Karen Matar

Reem Amine

Jamie Reese

Sunil K Srivastava

Justis P Ehlers

Affiliations

Soon will be listed here.

Abstract

To explore opportunities for individualized postoperative positioning duration in macular hole (MH) surgery. : This post hoc analysis comprised eyes that had full-thickness MH (FTMH) repair in the prospective DISCOVER intraoperative optical coherence tomography (OCT) study. Preoperative spectral-domain OCT (SD-OCT) and postoperative day 1 (POD1) trans-tamponade OCT were analyzed. Preoperative SD-OCT macular cubes were imported and analyzed using a machine learning-enhanced segmentation platform. Nine preoperative segmentation parameters were analyzed (maximum foveal height, apex area, base area, central foveal area, maximum apex diameter, maximum base diameter, maximum depth, minimum foveal width, volume). In addition, 2 new metrics-the macular hole index and tractional hole index-were calculated. POD1 trans-tamponade OCTs were obtained and evaluated for hole closure. : Of the 66 eyes with an FTMH, 16 (24%) had a chronic MH and 5 (8%) were reoperations from FTMH nonclosure after previous surgery. Nine eyes (14%) had an open MH on POD1 trans-tamponade OCT (6 chronic MHs [66%]; 2 reoperations [22%]); the remaining 57 MHs (86%) were closed. Multiple segmentation parameters were significantly associated with POD1 closure. : Volumetric MH measurements and trans-tamponade POD1 OCT closure status are important in predicting MH closure speed and the need for postoperative positioning. Individualized positioning duration in MH could lower perioperative morbidity and vastly enhance quality of life.

Citing Articles

Minimal Gas Vitrectomy and As-Needed Positioning Duration for Idiopathic Macular Holes.

Chantarasorn Y, Kritfuangfoo T, Pokawattana I, Hemarat K, Tangjitwilaikul C Ophthalmol Ther. 2025; .

PMID: 40085367 DOI: 10.1007/s40123-025-01114-1.

References

Guillaubey A, Malvitte L, Lafontaine P, Jay N, Hubert I, Bron A . Comparison of face-down and seated position after idiopathic macular hole surgery: a randomized clinical trial. Am J Ophthalmol. 2008; 146(1):128-134. DOI: 10.1016/j.ajo.2008.02.029. View

Au Eong K, Beatty S, Thomas W, Sen V, Turner G . Pulmonary embolism following head positioning for retinal reattachment surgery in a young patient with factor V leiden mutation. Arch Ophthalmol. 2000; 118(9):1300-1. View

Xu D, Yuan A, Kaiser P, Srivastava S, Singh R, Sears J . A novel segmentation algorithm for volumetric analysis of macular hole boundaries identified with optical coherence tomography. Invest Ophthalmol Vis Sci. 2012; 54(1):163-9. DOI: 10.1167/iovs.12-10246. View

Pendergast S, McCuen 2nd B . Visual field loss after macular hole surgery. Ophthalmology. 1996; 103(7):1069-77. DOI: 10.1016/s0161-6420(96)30565-4. View

Ehlers J, Goshe J, Dupps W, Kaiser P, Singh R, Gans R . Determination of feasibility and utility of microscope-integrated optical coherence tomography during ophthalmic surgery: the DISCOVER Study RESCAN Results. JAMA Ophthalmol. 2015; 133(10):1124-32. PMC: 4936530. DOI: 10.1001/jamaophthalmol.2015.2376. View

Wakely L, Rahman R, Stephenson J . A comparison of several methods of macular hole measurement using optical coherence tomography, and their value in predicting anatomical and visual outcomes. Br J Ophthalmol. 2012; 96(7):1003-7. DOI: 10.1136/bjophthalmol-2011-301287. View

Salam A, Harrington P, Raj A, Babar A . Bilateral Ulnar nerve palsies: an unusual complication of posturing after macular hole surgery. Eye (Lond). 2004; 18(1):95-7. DOI: 10.1038/sj.eye.6700515. View

Yee P, Sevgi D, Abraham J, Srivastava S, Le T, Uchida A . iOCT-assisted macular hole surgery: outcomes and utility from the DISCOVER study. Br J Ophthalmol. 2020; 105(3):403-409. DOI: 10.1136/bjophthalmol-2020-316045. View

Ehlers J, Uchida A, Hu M, Figueiredo N, Kaiser P, Heier J . Higher-Order Assessment of OCT in Diabetic Macular Edema from the VISTA Study: Ellipsoid Zone Dynamics and the Retinal Fluid Index. Ophthalmol Retina. 2019; 3(12):1056-1066. PMC: 6899163. DOI: 10.1016/j.oret.2019.06.010. View

10.

Lange C, Membrey L, Ahmad N, Wickham L, MacLaren R, Solebo L . Pilot randomised controlled trial of face-down positioning following macular hole surgery. Eye (Lond). 2011; 26(2):272-7. PMC: 3272183. DOI: 10.1038/eye.2011.221. View

11.

Holekamp N, Meredith T, Landers M, SNYDER W, Thompson J, Berman A . Ulnar neuropathy as a complication of macular hole surgery. Arch Ophthalmol. 1999; 117(12):1607-10. DOI: 10.1001/archopht.117.12.1607. View

12.

Ehlers J, Uchida A, Srivastava S, Hu M . Predictive Model for Macular Hole Closure Speed: Insights From Intraoperative Optical Coherence Tomography. Transl Vis Sci Technol. 2019; 8(1):18. PMC: 6366005. DOI: 10.1167/tvst.8.1.18. View

13.

Chow D, Chaudhary K . Optical coherence tomography-based positioning regimen for macular hole surgery. Retina. 2015; 35(5):899-907. DOI: 10.1097/IAE.0000000000000410. View

14.

Ehlers J, Yuan A, Kaiser P, Dhoot D, Sears J, Martin D . Trans-tamponade optical coherence tomography: postoperative imaging in gas-filled eyes. Retina. 2013; 33(6):1172-8. DOI: 10.1097/IAE.0b013e31827b6565. View

15.

Venkatesh R, Mohan A, Sinha S, Aseem A, Yadav N . Newer indices for predicting macular hole closure in idiopathic macular holes: A retrospective, comparative study. Indian J Ophthalmol. 2019; 67(11):1857-1862. PMC: 6836585. DOI: 10.4103/ijo.IJO_364_19. View

16.

Pasu S, Bell L, Zenasni Z, Lanz D, Simmonds I, Thompson A . Facedown Positioning Following Surgery for Large Full-Thickness Macular Hole: A Multicenter Randomized Clinical Trial. JAMA Ophthalmol. 2020; 138(7):725-730. PMC: 7206530. DOI: 10.1001/jamaophthalmol.2020.0987. View

17.

Yamashita T, Sakamoto T, Yamashita T, Sonoda S, Yamakiri K, Otsuka H . Individualized, spectral domain-optical coherence tomography-guided facedown posturing after macular hole surgery: minimizing treatment burden and maximizing outcome. Retina. 2014; 34(7):1367-75. DOI: 10.1097/IAE.0000000000000087. View

18.

Shah S, Manjunath V, Rogers A, Baumal C, Reichel E, Duker J . Optical coherence tomography-guided facedown positioning for macular hole surgery. Retina. 2013; 33(2):356-62. PMC: 3758113. DOI: 10.1097/IAE.0b013e318263d0e8. View

19.

Tornambe P, Poliner L, Grote K . Macular hole surgery without face-down positioning. A pilot study. Retina. 1997; 17(3):179-85. DOI: 10.1097/00006982-199705000-00001. View

20.

Elborgy E, Starr M, Kotowski J, Chehade J, Iezzi R . NO FACE-DOWN POSITIONING SURGERY FOR THE REPAIR OF CHRONIC IDIOPATHIC MACULAR HOLES. Retina. 2020; 40(2):282-289. DOI: 10.1097/IAE.0000000000002396. View