First Author: D.Guven TURKEY
Co Author(s): M. Demir S. Tiryaki Demir H. Kacar A. Alkan E. Karatas M. Karapapak
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We want to present the vascular and topographical features of both non-operated and operated full thickness macular hole eyes using optical coherence tomography angiography (OCT-A). We want to reveal the characteristics of closed macular holes versus persistent/open macular holes after pars plana vitrectomy with gas tamponade with regard to features of the superficial and deep capillary plexus.
This is a cross-sectional clinical study in which macular holes patients who were evaluated with OCT-A during a one-week period when OCT-A was available and analysis could be made, are involved.
Eleven eyes of 10 consecutive macular hole(MH) patients were evaluated by detailed ophthalmological examination, SD-OCT (Topcon 3D OCT-2000 FA plus) and OCT-A (AngioVue, OptoVue Inc) during a week-period. Medical and ocular history, measurement of the best corrected visual acuity (BCVA), slit-lamp examination of anterior segment, dilated fundus examination, measurement of intraocular pressure were considered. aetiology for the MH, presence of any intervention, characteristics of the hole edges imaged by OCT at presentation and last visit, flow density and flow area of the superficial and deep capillary plexus imaged by OCT-A at the last visit were evaluated. Using OCT-A, the SCP in the ganglion cell layer and the DCP beneath the inner plexiform layer were evaluated.
Eleven eyes of 10 patients were evaluated. Sex ratio was 50%. Mean age was 65.7 years (60-71 years). Nine eyes were phakic, 2 were pseudophakic. MH was idiopathic in 7 eyes, due to trauma in one eye and following pars plana vitrectomy (PPV) for pseudophakic retinal detachment in 3 eyes. Vitreomacular traction was present in 7 eyes, and epiretinal membrane was in one eye. Duration of decreased vision was 4.36 months (1-12 months). PPV with internal limiting membrane removal and gas exchange was performed in 9 eyes, 7 of which also underwent phacoemulsification with intraocular lens implantation. Two eyes with idiopathic aetiology and duration of 6 and 12 months, hole diameter of 840 and 655 µm and BCVA of 0.1 and 0.15 were followed. Preoperative mean greatest MH diameter was 554µm. (343-787µm) Except one eye, all the holes were large (>400µm) Mean postoperative follow up period was 10 months (3-19 months). Mean preoperative BCVA was 0.12 (0.03-0.2) and postoperative mean BCVA was 0.31 (0.05-0.7). BCVA increased in all but one eye, all MH were closed except for this traumatic MH case. Foveal flow density of closed MH eyes versus normal eyes were 34.60% versus 26.11% in SCP, 41.67% versus 31.08% in DCP.
Non-operated idiopathic MH eyes had a wheel-like pattern of DCP with cystic spaces at the hole edges. Traumatic operated persistent MH showed a few small cystic spaces with rarefaction of the vascular network. En face OCT revealed dissociated optic nerve fibre layer appearance in the operated idiopathic MH eyes, OCT-A showed relatively smaller foveal avascular zone, with vascular pattern around a few cystic spaces if any. Higher foveal flow density of both SCP/DCP in the operated and closed eyes versus normal eyes was a striking finding. Flow area in SCP and DCP were not found to be conclusive in this small group. When compared with the fellow healthy eyes, in full thickness MH eyes, there were hyporeflective spaces around the hole edges accompanied with vascular pattern in SCP and DCP. In closed MH eyes, either there were no cystic spaces or a few small ones. In this case series the number of the patients is small but, we think that the relationship between of these cystic spaces and vascular patternaround them in the presence of full thickness MH and disappearance after closure of the MH needs to be emphasized.