Author reply

Abstract

We thank Dr Rubowitz for his careful review and constructive comments. His thoughtful discussion of the differing methods for classifying macular holes is relevant to our article and to current clinical decision making. In the study, we relied primarily on biomicroscopic examination for the diagnosis and classification of a macular hole. Although a single classification system would be desirable and, presumably, would diminish discrepancies, we certainly agree with the potential merit of correlating current biomicroscopic classification systems with optical coherence tomography findings. Hence, rather than a more refined unifying system, based solely on biomicroscopic examination, we anticipate adoption of newer classification systems incorporating the additional information and accuracy made available by widespread use of optical coherence tomography. Dr Rubowitz has pointed out that such an approach will require validation, and we agree with him.For the purpose of clarification of our principal findings, it should be emphasized that it was not known at study onset that stage 2 holes would respond more favorably than larger holes. The case-by-case data presented in our Table 1, however, indicate a clear difference between holes responding with closure (mean diameter, 223 μm, consistent with stage 2 holes) and those that did not (mean diameter, 537 μm). Additional factors examined in relation to hole closure are presented in our Table 3—notably, better pretreatment vision was a positive predictive factor. It is on the basis of these findings that we present this procedure as applicable to stage 2 macular holes.Again, we thank Dr Rubowitz for his excellent and supportive comments. We acknowledge that this is a small study, and it is our intention to present our findings conservatively. A recent report has also demonstrated the successful result of 6 cases with stage 2 macular hole by gas-assisted posterior vitreous detachment.1Jorge R. Costa R.A. Cardillo J.A. et al.Optical coherence tomography evaluation of idiopathic macular hole treatment by gas-assisted posterior vitreous detachment.Am J Ophthalmol. 2006; 142: 869-871Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar Based on the available data, we are able to share in Dr Rubowitz’s enthusiasm for further evaluation of this new approach to macular hole management. We thank Dr Rubowitz for his careful review and constructive comments. His thoughtful discussion of the differing methods for classifying macular holes is relevant to our article and to current clinical decision making. In the study, we relied primarily on biomicroscopic examination for the diagnosis and classification of a macular hole. Although a single classification system would be desirable and, presumably, would diminish discrepancies, we certainly agree with the potential merit of correlating current biomicroscopic classification systems with optical coherence tomography findings. Hence, rather than a more refined unifying system, based solely on biomicroscopic examination, we anticipate adoption of newer classification systems incorporating the additional information and accuracy made available by widespread use of optical coherence tomography. Dr Rubowitz has pointed out that such an approach will require validation, and we agree with him. For the purpose of clarification of our principal findings, it should be emphasized that it was not known at study onset that stage 2 holes would respond more favorably than larger holes. The case-by-case data presented in our Table 1, however, indicate a clear difference between holes responding with closure (mean diameter, 223 μm, consistent with stage 2 holes) and those that did not (mean diameter, 537 μm). Additional factors examined in relation to hole closure are presented in our Table 3—notably, better pretreatment vision was a positive predictive factor. It is on the basis of these findings that we present this procedure as applicable to stage 2 macular holes. Again, we thank Dr Rubowitz for his excellent and supportive comments. We acknowledge that this is a small study, and it is our intention to present our findings conservatively. A recent report has also demonstrated the successful result of 6 cases with stage 2 macular hole by gas-assisted posterior vitreous detachment.1Jorge R. Costa R.A. Cardillo J.A. et al.Optical coherence tomography evaluation of idiopathic macular hole treatment by gas-assisted posterior vitreous detachment.Am J Ophthalmol. 2006; 142: 869-871Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar Based on the available data, we are able to share in Dr Rubowitz’s enthusiasm for further evaluation of this new approach to macular hole management. Classification of Macular HolesOphthalmologyVol. 114Issue 10PreviewThe article by Mori et al1 regarding the use of intravitreal gas injection as a treatment for stage 2 macular holes was intriguing and raises new possibilities in the care of these patients. Full-Text PDF