Prognostic factors in vitrectomy for lamellar macular hole assessed by spectral-domain optical coherence tomography

Abstract

Purpose: To evaluate the association between the macular structure on spectral-domain optical coherence tomography (SD-CT) and visual outcome after vitrectomy for lamellar macular hole (LMH).

Methods: Best-corrected visual acuity (VA) and SD-OCT images of the macula were assessed before and after surgery in 30 eyes of 30 patients with a LMH. Preoperative VA and SD-OCT features were investigated as predictors of surgical outcome.

Results: Mean patient age was 65 years with female predominance (77%). Visual acuity improved in 19 eyes (63%) with an overall mean improvement of 1 Snellen line (from 20/65 to 20/50; p = 0.002) at a mean of 18 months after vitrectomy. Subgroup analysis showed that statistically significant visual benefit was only observed in patients with an intact photoreceptor inner segment/outer segment (IS/OS) junction (p = 0.003), with foveal thickness bigger than 100 μm (p = 0.004) and with initial VA better than 20/100 (p = 0.003). The most efficient model to predict final VA was the combination of preoperative VA and the presence or absence of IS/OS disruption (r(2) = 0.77, p < 0.001).

Conclusions: Poor initial VA, the presence of a disrupted IS/OS junction or a thin fovea on preoperative SD-OCT predicted poor vision outcome after LMH surgery.