Idiopathic Macular Hole Eyes Research Articles

Optical coherence tomography angiography features of the chorioretinal complex and choriocapillaris perfusion before and after vitrectomy with conventional versus fovea-sparing internal limiting membrane peeling for idiopathic macular hole

Purpose: To assess optical coherence tomography angiography (OCTA)-measured changes in the chorioretinal complex and choriocapillaris perfusion density in the macula before and after vitrectomy with fovea-sparing versus conventional internal limiting membrane (ILM) peeling for idiopathic macular hole (IMH). Material and Methods: Eyes with stage-2 to stage-4 holes as per the classification by Gass received 25-G vitrectomy with conventional or fovea-sparing ILM peeling and gas tamponade with 20% SF6 or 15% С3F8. IMH diameter, foveal avascular zone (FAZ) area in the deep retinal plexus and choriocapillaris perfusion density (CPD) were assessed before and 1 month after surgery. Results: Totally, 70 patients had an IMH surgery in 71 eyes. The mean age ± standard deviation (SD) was 65.7 ± 6.8 years, median IMH duration (interquartile range or IQR), 3.0 (1.0-6.0) months, median best-corrected visual acuity or BCVA (IQR), 0.19 (0.1-0.25), and median maximum IMH diameter (IQR), 673.5 (549.5–1010.5) µm. In eyes with IMH and fellow eyes, the median FAZ area (IQR) was 0.51 (0.15–0.53) mm2, and 0.46 (0.10–0.74) mm2, respectively (р = 0.49), and mean CPD ± SD, 0.11 ± 0.06, and 0.29 ± 0.13 (р = 0.0001), respectively. Thirty-four eyes received conventional ILM peeling and 37 eyes, fovea-sparing ILM peeling, and there was no significant intergroup difference in baseline characteristics. One month after surgery, IMH closure was achieved in 63/71 eyes (i.e., the closure rate was 88.7% for total operated eyes, and 88.2% and 89.2%, respectively, for eyes in conventional ILM peeling and fovea-sparing ILM peeling groups), and median BCVA (IQR) improved to 0.60 (0.4–0.8) (р = 0.00001). After IMH closure, in operated eyes, median FAZ area (IQR) decreased to 0.30 (0.12–0.6) mm2, but the difference was not significant, whereas mean CPD ± SD increased significantly from 0.11 ± 0.06 to 0.25 ± 0.10 (р = 0.0001). No significant difference in OCTA-based retinal microcirculation and choriocappillaris characteristics was observed between the conventional ILM peeling and fovea-sparing ILM peeling groups. Conclusion: The presence of macular hole is accompanied by abnormal perfusion in the choriocapillaris, but the CPD recovers after IMH closure. Postoperative CPD recovery is not influenced by the type (conventional or fovea-sparing) of ILM peeling.

Microstructural and hemodynamic changes in the fundus after pars plana vitrectomy for different vitreoretinal diseases.

Pars plana vitrectomy is the standard treatment for several vitreoretinal diseases. Continuous improvements in ophthalmic surgical techniques have led to excellent postoperative recovery of the anatomic structure of the fundus. However, postoperative visual outcomes are not always satisfactory. A literature search of articles published before 31 December 2022 was conducted on PubMed using the following keywords: "diabetic retinopathy," "rhegmatogenous retinal detachment," "idiopathic epiretinal membrane," "idiopathic macular hole," "vitrectomy," "optical coherence tomography," "optical coherence tomography angiography," "microstructure," "microstructural," "hemodynamic," "hemodynamics," and "microcirculation." Additional studies were identified by hand-searching references for relevant studies. Articles were screened for language, repetition, and relevance to the direction of study. Studies with a sample size ≥ 7 and the final follow-up time ≥ 4weeks after vitrectomy were included in this review. Only articles published in English were included. Articles not related to our topic were excluded. Reviews and single case reports were excluded. We structured this review by disease category. The thickness of the retina and choroid, the area of the foveal avascular zone, the vessel density of the retinal and choroidal capillary plexus, and the potential association of related parameters with postoperative visual outcomes are the main outcome measures of studies included in this review. A total of 48 studies were included in this review. There were contradictory results regarding the association between postoperative microcirculatory parameters and visual acuity in patients with diabetic macular edema, with some studies concluding that improvement in perimacular microcirculation may be an important factor that affects visual acuity, and others concluded that postoperative improvement in visual acuity was not related to changes in macular blood flow. The results of studies on the relationship between postoperative microstructural and microcirculatory parameters and visual acuity in rhegmatogenous retinal detachment, idiopathic epiretinal membrane, and idiopathic macular hole eyes have been inconsistent. In gas tamponade macula-off rhegmatogenous retinal detachment eyes, postoperative best-corrected visual acuity has been reported to correlate positively with vessel density of deep capillary plexus and negatively with foveal avascular zone area of superficial capillary plexus and deep capillary plexus. In silicone oil tamponade macula-off rhegmatogenous retinal detachment eyes, best-corrected visual acuity has been reported to be positively correlated with the retinal thickness of the parafoveal 3mm temporal quadrant and positively correlated with the vessel density of the superficial capillary plexus in the foveal, parafoveal, and perifoveal area. In addition, best-corrected visual acuity was worse and associated with reduced thickness of the inner retina, ganglion cell layer, outer plexiform layer, and outer nuclear layer in silicone oil tamponade rhegmatogenous retinal detachment eyes compared to gas tamponade. Postoperative best-corrected visual acuity in idiopathic epiretinal membrane eyes was positively correlated with the foveal avascular zone area but negatively correlated with full retinal thickness and inner retinal thickness in the foveal and parafoveal areas. Improvement in postoperative best-corrected visual acuity in idiopathic macular hole eyes was associated with reduced inner retinal thickness and reduced foveal avascular zone area. Microstructural and hemodynamic changes are involved in the recovery process after PPV for different vitreoretinal diseases. The thickness of each retinal layer in different regions of the macula, foveal avascular zone area, and vessel density of different retinal capillary plexuses in different macular regions may be potential prognostic factors for postoperative visual recovery. However, the results of the existing literature are inconsistent and require further study.

Comparison of the morphological characteristics of the choroidal sublayer between idiopathic macular holes and epiretinal membranes with automatic analysis

PurposeTo compare the choroidal sublayer morphologic features between idiopathic macular hole (IMH) and idiopathic epiretinal membrane (iERM) on spectral-domain optical coherent tomography (SD-OCT) using an automatic segmentation model.MethodsThirty-three patients with idiopathic IMHs and 44 with iERMs who underwent vitrectomies were involved. The enhanced depth imaging mode of SD-OCT was used to obtain the B-scan image after single line scanning of the macular fovea. The choroidal sublayer automatic analysis model divides the choroidal into the choroidal large vessel layer, the middle vessel layer and the small vessel layer (LVCL, MVCL and SVCL, respectively) and calculates the choroidal thickness (overall, LVCL, MVCL and SVCL) and vascular index (overall, LVCL, MVCL and SVCL). The morphological characteristics of the choroidal sublayer in the ERM eyes and the IMH eyes were compared.ResultsThe mean choroidal thickness in the macular centre of the IMH eyes was significantly thinner than that of the ERM eyes (206.35 ± 81.72 vs. 273.33 ± 82.31 μm; P < 0.001). The analysis of the choroidal sublayer showed that the MVCL and SVCL macular centres and 0.5–1.5 mm of the nasal and temporal macula were significantly thinner in the IMH eyes than in the ERM eyes (P < 0.05), and there was a difference in the macular centre of the LVCL between the two groups (P < 0.05). In contrast, the choroidal vascular index of the macular centre in the IMH eyes was significantly higher than that in iERM eyes (0.2480 ± 0.0536 vs. 0.2120 ± 0.0616; P < 0.05). There was no significant difference in the CVI of other parts of the macula, the LVCL or MVCL between the two groups.ConclusionThe choroidal thickness of the IMH eyes was significantly thinner than that of the iERM eyes, which was mainly observed in 3 mm of the macular centre and the MVCL and SVCL layers of the choroid. The choroidal vascular index of the IMH eyes was higher than that of the iERM eyes. These findings suggest that the choroid may be involved in the pathogenesis of IMH and iERM.

Functional features in patients with idiopathic macular hole treatment via OCT angiography.

To evaluate the optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy. This prospective study included 25 patients diagnosed with IMH in Shanxi eye hospital from August 2019 to December 2021. The study was divided into 3 groups: IMH eyes, fellow eyes and normal eyes. All unilateral IMH eyes underwent vitrectomy. There were significant differences in superficial retinal blood flow density (SRBFD, P < .001) and choroidal blood flow density (CBFD) between IMH and healthy control eyes before operation (P < .05). There was significant difference in SRBFD between fellow eyes and normal eyes (P = .038). The changes of SRBFD and CBFD in IMH eyes before and after operation were statistically significant (P < .05). The CBFD at 6 months after operation is negatively correlated with LogMAR visual acuity, and the CBFD of the fellow eye is also negatively correlated with LogMAR visual acuity. The SRBFD and CBFD had no correlation with the diameter of macular hole before and after operation. SRBFD and CBFD increased after vitrectomy, indicating that the blood supply of retina and choroid were partially restored after vitrectomy. There was no correlation between SRBFD, CBFD and hole diameter, but there was correlation between choroidal blood flow and LogMAR visual acuity.

Choriocapillary regional characteristics in idiopathic macular holes using optical coherence tomography angiography

Purpose: To evaluate the characteristics of vascular density (VD) of the retinal capillary plexuses in idiopathic macular hole (IMH), the fellow eye, and healthy control eyes by optical coherence tomography angiography (OCTA). Methods: A retrospective cases series study involving 20 unilateral eyes (20 patients) with IMH, the unaffected fellow eyes (n = 20) and 20 health controls, with age- and sex-matched, was conducted in Shanxi Eye Hospital from January 2019 to December 2021. VD of the retinal capillary plexuses measurements were obtained by OCTA. Results: Four quadrants of superficial capillary plexuses (SCP) in IMH eyes were not significant compared with that in the unaffected fellow eyes (all P > 0.05). The four quadrants of deep capillary plexuses (DCP) in IMH eyes were lower than that in the unaffected fellow eyes (all P < 0.05). Different regions retinal thickness in the IMH eyes was higher than that in the unaffected fellow eyes (all P < 0.05). a significant negative correlation between deep vessel density and retinal thickness in different quadrants among IMH eyes (all P < 0.05). Additionally, the correlation between the vascular density of SCP and retinal thickness was significant in macular fovea area (= 0.519, P = 0.019). <0.001. Conclusions: The morphology of retina and choroid in idiopathic macular hole is different from that in fellow eye. The thickness of choroid in the fovea area of the unaffected eye also showed a decreasing trend. Taken together, the mechanism of macular hole may be further understood, that is, the decrease of choroid thickness may occur before the macular hole formation. It was verified again that the choroidal blood flow area in macular fovea of IMH patients was significantly lower than that in fellow eyes and healthy eyes.

Morphological and Functional Features in Patients with Idiopathic Macular Hole Treatment.

PurposeTo evaluate the multifocal electroretinogram (mfERG) and optical coherence tomography (OCT) angiography features in patients with idiopathic macular hole (IMH) before and after vitrectomy.Patients and MethodsThis prospective study was conducted at Shanxi Eye Hospital from January 2019 to December 2021. Twenty-five eyes of 25 patients with unilateral IMH, the unaffected fellow eyes, and 30 eyes of healthy patients were investigated. All unilateral IMH eyes underwent vitrectomy.ResultsThe IMH eyes had significantly delayed latency (rings 2–5) of mfERG compared with the healthy control eyes, and the amplitude density of all rings of mfERG was reduced (P < 0.05). When comparing the mfERG components before surgery and at the follow-up, the amplitude density of IMH eyes (ring 1, 3, 4 and 5) was increased significantly (P < 0.05). The delayed implicit times of the second and fifth ring were significantly shortened compared with those of preoperative eyes (P < 0.05). The mean delayed implicit time of mfERG in six months after surgery was negatively correlated with visual acuity (r = −0.890, P = 0.043). Significant differences of superficial retinal blood flow density (SRBFD, P < 0.001) and choroidal blood flow density (CBFD) (P < 0.05) got via OCTA were found between IMH before surgery and healthy control eyes. SRBFD of the fellow eyes were significantly different with the healthy control eyes (P = 0.038). Statistically significance of SRBFD and CBFD changes in IMH eyes were found before and after surgery (P < 0.05).ConclusionIMH eyes had a decreased amplitude density and a delayed implicit time in some regions. Additionally, SRBFD and CBFD were both increased after vitrectomy, which suggests that the blood supply of the retina and choroid is partially restored after vitrectomy.

Machine learning-based prediction of anatomical outcome after idiopathic macular hole surgery.

BackgroundTo develop a machine learning (ML) model for the prediction of the idiopathic macular hole (IMH) status at 1 month after vitrectomy and internal limiting membrane peeling (VILMP) surgery.MethodsA total of 288 IMH eyes from four ophthalmic centers were enrolled. All eyes underwent optical coherence tomography (OCT) examinations upon admission and one month after VILMP. First, 1,792 preoperative macular OCT parameters and 768 clinical variables of 256 eyes from two ophthalmic centers were used to train and internally validate ML models. Second, 224 preoperative macular OCT parameters and 96 clinical variables of 32 eyes from the other two centers were utilized for external validation. To fulfill the purpose of predicting postoperative IMH status (i.e., closed or open), five ML algorithms were trained and internally validated by the ten-fold cross-validation method, while the best-performing algorithm was further tested by an external validation set.ResultsIn the internal validation, the mean area under the receiver operating characteristic curves (AUCs) of the five ML algorithms were 0.882–0.951. The AUC, accuracy, sensitivity, and specificity of the best-performing algorithm (i.e., random forest, RF) were 0.951, 0.892, 0.973, and 0.904, respectively. In the external validation, the AUC of RF was 0.940, with an accuracy of 0.875, a specificity of 0.875, and a sensitivity of 0.958.ConclusionsBased on the preoperative OCT parameters and clinical variables, our ML model achieved remarkable accuracy in predicting IMH status after VILMP. Therefore, ML models may help optimize surgical planning for IMH patients in the future.

Ultrastructural study of closed macular hole- preliminary application of a novel high magnification module combining with OCT

BackgroundAs a novel high magnification module (HMM) combining with OCT (OCT-HMM) is able to detect the microstructure of retina, we apply it to explore the ultrastructure of the macula after closure of the idiopathic macular hole (IMH) by surgery.MethodsThis is an observational case series study in which patients with full-thickness IMHs who had undergone successful macular closure by vitrectomy and internal limiting membrane peeling and healthy subjects were recruited. After comprehensive ophthalmic examinations, the images of macular area were obtained and collected by professional operators using OCT-HMM. Then images were independently analyzed by 4 masked vitreoretinal specialists.ResultsA total of 24 IMH eyes and 42 healthy eyes were examined. HMM images were obtained in 10 IMH eyes. Among them, 4 eyes whose macula closed completely with recovery of photoreceptor layer presented a dark arc nasal to the fovea, oriented to the optic, and the notch of arc faced temporally. Six eyes in which the macula closed incompletely with photoreceptor cells loss revealed a dark ring with uneven bright spots inside. The other 14 eyes failed to obtain clear images by OCT-HMM. The contra lateral eyes of the patients and the healthy subjects’ eyes succeeded to obtain the HMM images which displayed evenly grey background thickly covered with tiny bright dots that was in similar size and evenly and widely distributed and there no dark arc or ring. OCT B-scan and IR images could be acquired in all of the IMH and healthy eyes.ConclusionThe preliminary application of HMM has supplied us a brand-new insight into the microstructure of closed IMH. A dark arc sign could be detected with OCT-HMM in the macula which was functionally closed after surgery that was probably the healing mark on a microstructure photoreceptors level. Its existence and shape indicated that the functional closure followed by a retinal displacement mainly horizontally from temporal side to nasal side but not symmetric centripetally.

Minimal internal limiting membrane peeling with ILM flap technique for idiopathic macular holes: a preliminary study

BackgroundInternal limiting membrane (ILM) peeling increases the idiopathic macular hole (IMH) closure rate but causes the inner retina dimplings. This study is to introduce a method to minimally peel the ILM, and with the ILM flap to ensure the IMH closure.MethodsTwelve consecutive IMH eyes were treated with the minimal ILM peeling with ILM flap technique. The ILM around the MH is peeled off in an annular shape with a width of approximately 200 to 300 μm. A tongue-shape ILM flap is created in the superior retina and the inferior margin of ILM is not peeled off. The ILM flap is then inverted to cover the MH, followed by fluid-air exchange and air or silicon tamponade. Spectral domain-optical coherence tomography (SD-OCT) and en face OCT for morphological assessment, best corrected visual acuity (BCVA) and multifocal electroretinogram (ERG) for functional evaluation were performed at baseline and at each postoperative follow-up.ResultsAll the 12 eyes achieved macular hole closure on SD-OCT after surgery (100%). At baseline, the mean preoperative BCVA was 0.83 ± 0.33 and it improved to 0.39 ± 0.28 postoperatively (p < 0.001). En face OCT showed the inner retinal dimplings were localized only in superior ILM-free retinas (7 eyes). The mERG response density in the central (R1), para-central (R2), R1/R2 ring ratios were remarkably improved at the last follow-up (p = 0.001, p = 0.033, p = 0.018, respectively).ConclusionsThe minimal ILM peeling with ILM flap technique can achieve favorable MH closure with less inner retinal dimplings and has promising visual recovery for IMH eyes.

Quantitative proteomics analysis of vitreous body from type 2 diabetic patients with proliferative diabetic retinopathy

BackgroundTo compare the abundance of vitreous proteins between the patients with proliferative diabetic retinopathy (PDR) and idiopathic macular hole (IMH).MethodsIn this study, we performed mass spectrometry-based label-free quantitative proteomics analysis of vitreous samples from type 2 diabetic patients with PDR (n = 9) and IMH subjects (n = 9) and identified the abundance of 610 proteins.ResultsOut of 610 proteins, 64 proteins (Group A) were unique to PDR patients, while 212 proteins (Group B) could be identified in IMH vitreous only. Among the other 334 proteins that could be detected in both PDR and IMH eyes, 62 proteins differed significantly (p < 0.05, fold change > 2), which included 52 proteins (Group C) and 10 proteins (Group D) over- and under-expressed in PDR vitreous compared with the control. All proteins in these four groups were counted as significant proteins in our study.ConclusionsWe identified and quantified 610 proteins in total, which included 338 significant proteins in our study. Protein distribution analysis demonstrated a clear separation of protein expression in PDR and IMH. The protein function analysis illustrated that immunity and transport related proteins might be associated with PDR.

The optic nerve head perfusion and its correlation with the macular blood perfusion in unilateral idiopathic macular hole: an optical coherence tomography angiography study.

To compare the optic nerve head (ONH) perfusion in both eyes of unilateral idiopathic macular hole (IMH) with normal control group by using optical coherence tomography angiography (OCTA) and investigate its correlationship with the macular blood perfusion. We performed a prospective and cross-sectional study that included 19 patients with full-thickness unilateral IMH and 24 age- and sex-matched controls. All participants received OCTA test. The ONH perfusion was evaluated by the regions of peripapillary and whole en face (the sum of peripapillary and optic disc). The potential correlationship between ONH and parafovea were implied. All the data were performed using the nonparametric test. The mean values of ONH presented that normal control >IMH >unaffected eyes. A statistical variation was found between three groups in the region of temporal (P=0.007). Vessel density notablely decreased on the layers of superficial, deep and choroid of parafovea region in IMH group. The correlative coefficients showed that respectively whole en face and deep retina: r=0.528, peripapillary and deep retina: r=0.525, whole en face and choriocapillaries: r=0.569, peripapillary and choriocapillaries: r=0.504. Our study demonstrate a reduced ONH vessel density in both eyes of IMH patients and the vessel density of ONH in IMH eyes are positively correlated with both the retina capillary and choriocapillary in parafoveal. The reduction of vessel densities may indicate the hypoperfusion in IMH eyes.

Clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane flap covering technique for complicated macular hole

Objective To observe the clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane (ILM) flap covering technique for complicated macular hole (MH). Methods This is a retrospective case series. Twenty-one eyes of 20 patients who underwent vitrectomy combined with modified inverted ILM flap covering technique were enrolled in this study. Among these eyes, 9 eyes were idiopathic MH (IMH), with the mean basal diameter of (1 188.3±155.1) μm, minimum diameter of (626.9±86.2) μm, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) of 1.1±0.3; 2 eyes were MH with high myopia, with the mean basal diameter of (696.5±232.6) μm, minimum diameter of (259.0±69.3) μm, logMAR BCVA of 1.3; 5 eyes were high myopia MH with retinal detachment (RD), with the mean BCVA of 1.5±0.1; 3 eyes were rhegmatogenous RD (RRD) with MH, with the mean logMAR BCVA of 1.6; 2 eyes were MH after vitrectomy for RRD, with the mean basal diameter of (1 606.0±69.3) μm, minimum diameter of (909.0±387.5) μm, logMAR BCVA of 1.6. All patients received 23G or 25G vitrectomy after removal of posterior vitreous cortex intraoperatively. Indocyanine green staining assisted circle-wise ILM peeling was performed. ILM of diameter 1.5 disc-diameters around fovea was residual and loosened; perfluoronoctane assisted inverting superior or temporal residual ILM covering on macular hole. C3F8, gas or silicone oil tamponade was performed at the end. BCVA and hole closure were followed up for 1-4 months. C3F8, gas or silicone oil was tamponaded at the end. BCVA and hole closure were followed up for 1-4 months. Results MH of 21 eyes were closed after surgery. Nine IMH were closed at typeⅠ, with U shape closure in 7 eyes, V shape closure in 2 eyes. Two eyes of MH with high myopia, 3 eyes of RRD with MH, 2 eyes of MH after vitrectomy for RRD were closed at typeⅠ of U shape. Five eyes of high myopia MHRD including MH closure at typeⅠ of U shape 3 eyes, typeⅡ of W shape 2 eyes. The mean logMAR BCVA of IMH, MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes were 0.8±0.3, 0.9±0.2, 1.4±0.1, 0.7±0.3, 0.9±0.2, respectively. The mean postoperative logMAR BCVA in IMH eyes was improved compared preoperative one (P=0.02). There was no obvious change of pre-and postoperative logMAR BCVA in MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes (P=0.18, 0.10, 0.11, 0.18). Conclusion Vitrectomy combined with inverted ILM flap covering technique for complicated MH is an effective method to improve the success rate of MH closure and the visual function. Key words: Retinal Perforations/surgery; Vitrectomy

OCT angiography quantifying choriocapillary circulation in idiopathic macular hole before and after surgery.

To investigate the choriocapillary circulation in the macular area for eyes with unilateral idiopathic macular hole (IMH) before and after vitrectomy using optical coherence tomography angiography (OCTA). A prospective study of 25 patients with unilateral IMH who underwent vitrectomy and 30 age- and sex-matched healthy controls were recruited. Choriocapillary circulation was measured by OCTA to obtain two measurements: flow area and parafovea vessel density. Flow area and parafovea vessel density of choriocapillaris in the macular area were significantly smaller and lower in IMH eyes than unaffected fellow eyes and healthy control eyes (p < 0.001), while no difference was found between unaffected fellow eyes and the healthy control eyes. One month after vitrectomy, the choriocapillary flow area and parafovea vessel density of IMH eyes significantly increased compared to the peroperative measurements (p < 0.001). Association analysis found that choriocapillary circulation measurements were negatively correlated with macular hole diameters in IMH eyes (p < 0.001), but was independent with best-corrected visual acuity (BCVA). The macular choriocapillary flow area and parafovea vessel density in IMH eyes were lower than those of normal controls. In addition, the choriocapillary circulation was negatively correlated with macular hole diameter. Our findings suggested that choroidal circulation in the macular area might be affected by the intact structure of the fovea.

CHOROIDAL THICKNESS IN UNILATERAL IDIOPATHIC MACULAR HOLE: A Cross-Sectional Study and Meta-Analysis.

To investigate the choroidal thickness in unilateral idiopathic macular hole (IMH) eyes and compare them with normal control eyes using enhanced depth imaging optical coherence tomography (EDI-OCT). In this cross-sectional study, the subfoveal choroidal thickness (SFCT) and choroidal thickness at 1 mm and 3 mm nasal, temporal, superior, and inferior to the fovea of IMH eyes and normal control eyes were measured using EDI-OCT. Univariate and multivariate linear regression analyses were performed to evaluate the correlation between choroidal thickness at various locations and clinical factors. A meta-analysis was conducted using the Stata software package to calculate the summary of weighted mean differences (WMDs). Thirty-two unilateral IMH patients and 32 controls were enrolled in this study. The IMH eyes had a thinner choroid than the control eyes at all macular locations (all P < 0.001). Multivariate linear regression analysis further showed that the choroidal thickness at any of the nine points was significantly thinner in association with the IMH diagnosis, as well as being somewhat thinner in association with age and axial length. The result of our cross-sectional study was consistent with the meta-analysis with a pooled WMD of -56.99 (95% confidence interval [CI]: -68.58 to -45.41) for subfoveal choroidal thickness. The study of Chinese unilateral IMH patients, along with the comprehensive meta-analysis, suggested that the choroidal thickness at all macular locations in unilateral IMH eyes significantly decreased relative to the control group.

Choroidal thickness in idiopathic macular hole

PurposeTo measure the submacular choroidal thickness in eyes with idiopathic macular hole (IMH) compared with unaffected fellow eyes and normal control eyes. MethodsIn this single institutional retrospective comparative case-control study, 34 consecutive patients with IMH were included and compared with 30 normal age- and sex-matched eyes that were planned to have cataract surgery. The included eyes were divided into 4 groups: 41 eyes with IMH (A), 23 unaffected fellow eyes (B), 30 normal eyes (C), and 12 vitrectomized IMH eyes (D). ResultsThe choroidal thickness was significantly lower in all measured points in IMH eyes versus normal control eyes (subfoveal choroidal thickness [SFCT]: 215.76 ± 66.7 vs. 288.53 ± 72.0, P < 0.001) and at most locations in comparison between group B and C (SFCT: 231.79 ± 68.6 vs. 288.53 ± 72.0, P = 0.018). No significant difference was found in choroidal thickness between both eyes of patients with unilateral IMH (P = 0.81). The choroidal thickness was not altered after vitrectomy in the mean 6 months follow-up period. A negative correlation between the apical diameter and basal diameter of IMH and SFCT (P = 0.05) (P value of 0.034 and 0.05) and preoperative best-corrected visual acuity and apical and basal diameter of IMH (P = 0.006 and P = 0.029, respectively) was observed. ConclusionChoroidal thickness is reduced in both eyes of patients with IMH compared with normal age- and sex-matched control eyes.

The changes of retinal thickness in idiopathic macular hole eyes after vitrectomy combined with internal limiting membrane peeling surgery

Objective To observe the changes of retinal thickness in idiopathic macular hole eyes after vitrectomy combined with internal limiting membrane peeling. Methods The study included 40 eyes in 40 consecutive patients with idiopathic full-thickness macular holes who underwent vitrectomy and internal limiting membrane peeling. There were 10 males (10 eyes) and 30 female (30 eyes), the average age was (63.60±6.26) years, the average disease duration was (6.00±3.53) months. All patients were examined by spectral-domain optical coherence tomography to measure the foveal retinal thickness, parafoveal retinal thickness and every quadrant in 1, 3, 6 months after surgery. Results Compared foveal retinal thickness after 1 month with 3 month, the difference was significant (F=4.527, P=0.013). But foveal retinal thickness were not significantly different in 3 months and 6 months after surgery (F=2.031, P=0.971). The difference of average parafoveal retinal thickness between 1 month, 3 months and 6 months after surgery was not significant (F=2.011, P=0.139). The retinal thickness of the operated eyes were not significantly different from the normal fellow eyes in 1 month after surgery (t=0.651, P=0.519). And the foveal retinal thickness of the operated eyes and the normal fellow eyes are significantly different in 3 months and 6 months after surgery (t=-2.563, -2.524; P=0.015, 0.016). The thickness of temporal were thicker than other quadrant in 1 month, 3months and 6 months after surgery ( t=-3.701, -4.612, -4.125; P=0.014, 0.006, 0.009). Conclusion There is a transient increase in the foveal retinal thickness after macular hole surgery. Key words: Retinal perforations/surgery; Retina; Macula lutea; Tomography, optical coherence

Choroidal Thickness in Both Eyes of Patients with Unilateral Idiopathic Macular Hole

To compare the choroidal thickness in the macular area in eyes with an idiopathic macular hole (IMH) with that of unaffected fellow eyes and eyes of healthy controls. A cross-sectional study. Fifty patients with unilateral IMH and 50 healthy controls. Enhanced depth imaging was obtained by spectral-domain optical coherence tomography in all patients and controls. Eyes were divided into 3 groups: 50 eyes in group A (affected eyes with IMH), 48 eyes in group B (unaffected fellow eyes), and 50 eyes in group C (right eyes of age- and sex-matched controls). Two independent graders individually measured the choroidal thickness. Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid-scleral junction in the subfoveal area and 1 and 3 mm away from the fovea in the superior, inferior, nasal, and temporal regions. Apical and basal diameters of macular holes (MHs) were measured in eyes with IMH. Statistical analysis was conducted to compare mean choroidal thicknesses. Choroidal thickness was significantly decreased in affected IMH eyes compared with unaffected fellow eyes in 48 patients (P = 0.005, paired t test). The mean subfoveal choroidal thickness (SFCT) was 206.82 ± 67.09 μm in group A, 228.34 ± 80.71 μm in group B, and 248.88 ± 63.10 μm in group C. The choroid was significantly thinner in group A (P = 0.002) than in group C. The SFCT in unaffected fellow eyes was lower than in controls, but without statistical significance (P = 0.177). The apical and basal size of the MH were not related to the underlying choroidal thickness (apical r=-0.267, P = 0.072; basal r = -0.259, P = 0.082). Choroidal thickness was thinner in affected eyes with IMH and in fellow unaffected eyes. This may suggest a contributing role of the perfusion of the choroid in the pathogenesis of IMH. If these findings are confirmed, we suggest that the fellow eyes with thinner choroid may be prone to IMH and should be followed up frequently.