Session Title: Vitreoretinal Surgery V
Session Date/Time: Sunday 20/09/2015 | 11:00-13:00
Paper Time: 12:04
First Author: : S.Caprani ITALY
Co Author(s): : S. Donati J. Cattaneo C. Azzolini
PURPOSE:To evaluate OCT retinal layers modification as determinants for functional recovery after vitreoretinal surgery for idiopathic macular hole (IMH).
Department of Morphological and Surgical Sciences, Section of Ophthalmology, University of Insubria Circolo Hospital, Varese, Italy
This retrospective study included 23 eyes of 23 consecutive patients who underwent vitreoretinal surgery for IMH. We excluded patients affected by other different retinal diseases. Baseline and follow up evaluations at month 3, and 6 included complete ophthalmological evaluation, instrumental examination and clinical history. Functional evaluation was performed by ETDRS visual acuity and Amsler test. Morphological evaluation was performed by a deep analysis of retinal layers as well as mean retinal thickness (MRT) with SD OCT (Topcon 3D OCT, USA). According to the OCT evaluation of macular hole diameter, we divided patients in three groups (small IMH: 7 patients, medium IMH: 9 patients and large IMH: 7 patients). A standard 23G vitreoretinal surgery (Stellaris Vitrectomy Platform Bausch&Lomb, USA) was performed, posterior hyaloid and inner limiting membrane peeling by means of vital dyes completed by gas endotamponade, Statistical analysis was performed on collected data.
Clinical evaluation showed interesting results about functional and morphological modifications. Mean visual acuity significantly increased from 0,51 ± 0,22 LogMAR at baseline to 0,29±0,12 LogMAR at month 6, MRT significantly decreased from 393,54±195,36μm at baseline to 240,24±104,50μm at month 6. Intraretinal layers modification showed a recomposition of IS/OS layer in 17 patients and a persistence of foveal hyporeflective area in the outer layers in 3 patients, corresponding to patients with a low VA recovery. Retinal layers recomposition showed a progressive increase in all patients during follow up from the immediate post operative control to the last 12 month visit. Better results were obtained in the small IMH group.
OCT examination appears of great importance to investigate the reasons of visual recovery after macular hole surgery. To ensure a functional increase it is mandatory a recomposition of all retinal layers in particular in the outer segment. This process could be slow, not immediately perceivable in the post surgical controls.