Unilateral Idiopathic Macular Hole Research Articles

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.

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.

Comparison of retinal vascular arcade trajectory between eyes with an idiopathic macular hole and the healthy fellow eye.

We aimed to present a method to evaluate the retinal arcade vascular trajectory by measuring the distance between the retinal veins in eyes with idiopathic macular hole (IMH) and comparing this measurement with healthy fellow eyes. In this cross-sectional study 18 patients with unilateral IMH were enrolled. We used standard fundus photographs, which were obtained from each eye with a digital fundus camera using a 55-degree lens. The calculation of the retinal arcade vascular trajectories was done by drawing and measuring five vertical lines within the macular area. The mean age of the patients was 65 ± 9years. The between-groups differences of each vertical line were not statistically significant, except for the differences between the most temporal line, which was greater in the diseased group (9388 vs. 8322μm; P = 0.034). The ratio between the fifth (most temporal) and the third (fovea-center) vertical lines was greater than 1 (V-shape) in 72% of eyes with a macular hole, whereas it was less than one (U-shape) in 78% of control eyes (P = 0.003). We demonstrated that in eyes with an IMH the vascular arcade has more tendency to diverge on its path temporal to the fovea.

Foveal Morphology of Normal Fellow Eyes of Patients with Unilateral Macular Hole

To determine the morphology of the fovea in the ophthalmoscopically and tomographically normal fellow eyes of patients with a unilateral idiopathic macular hole (MH) and determine the association between foveal morphological parameters and foveal outer nuclear layer (ONL) thickness. Retrospective observational study. Two hundred three normal fellow eyes of patients with a unilateral MH and 216 normal eyes of 216 healthy subjects. All the eyes were examined using swept-source OCT. A built-in software was used to measure the average retinal and choroidal thickness in the center and in the inner 4 subfields defined in ETDRS. The total retinal thickness, thickness of 3 retinal layers at the fovea and parafovea (0.25 and 0.5 mm nasal and temporal from the fovea), and foveal floor width (FFW) were measured on a scan image of a horizontal line passing through the center of the fovea. We defined the thickness between the internal limiting membrane and outer plexiform layer as inner retinal thickness and the thickness between the external limiting membrane and retinal pigment epithelium as outer retinal thickness. Multiple regression analyses were performed with age, sex, axial length, and the presence of a posterior vitreous detachment as the dependent variables. OCT measurements and correlations between foveal parameters and foveal ONL thickness. The fellow eyes had a thinner central retinal subfield, thinner fovea, thinner ONL at all points except at 0.5 mm nasal, significantly thicker outer retina at all points, and a wider FFW (P= 0.040 to P < 0.0001). The foveal ONL thickness was significantly and positively correlated with the central subfield retinal thickness and foveal thickness and negatively correlated with the FFW (all P < 0.0001). The thinner and deeper fovea and the thinner ONL of the fellow eyes of patients with a unilateral MH make these eyes more susceptible to the formation of an MH.

Evaluation of optic nerve head perfusion in unilateral full-thickness idiopathic macular hole: an optical coherence tomography angiography study

Evaluation of optic nerve head perfusion in unilateral full-thickness idiopathic macular hole: an optical coherence tomography angiography study

Choroidal thickness changes and choriocapillary circulation analysis in macular holes using optical coherence tomography angiography.

To investigate the changes of subfoveal choroidal thickness (SFCT) and choriocapillary circulation in idiopathic macular holes (IMHs), the fellow eyes, and normal subjects using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA), and to explore the role of SFCT and choriocapillary circulation in the pathogenesis of IMH. A case series of 30 patients with unilateral IMH and 30 subjects, with age- and sex-matched, were included. Thirty eyes of 30 patients with unilateral IMH, the unaffected fellow eyes, and 30 eyes of age- and sex-matched healthy patients were studied. SFCT was measured by spectral domain enhanced depth imaging optical coherence tomography (EDI SD-OCT), while vascular density and blood flow area of choriocapillary circulation were obtained by OCTA. The SECT in IMH eyes (236.09±79.25 µm) was lower than that in the unaffected fellow eyes (249.71±86.10 µm) (P=0.040) and healthy control eyes (283.29±64.16 µm) (P=0.001). Also, the SFCT of the unaffected fellow eyes was lower than that of the healthy control eyes (P=0.033). The superficial blood flow area and vascular density of choriocapillary in the macular area were smaller and lower in the IMH eyes (2.84±0.35 mm2, 20.74%±8.26%) than the unaffected fellow eyes (3.19±0.23 mm2, 35.18%±5.20%) and healthy control eyes (3.26±0.24 mm2, 35.20%±6.49%) (P<0.001); however, no difference was observed between the unaffected fellow eyes and healthy control eyes. The SFCT in IMH eyes was lower than that of unaffected fellow eyes and matched control eyes. In addition, the choriocapillary blood flow area and vascular density were smaller and lower than those of the unaffected fellow eyes and normal controls. Our findings suggested that atrophy of choriocapillary might play an important role in the formation of IMH.

The Association between Foveal Floor Measurements and Macular Hole Size

Determining which factors influence idiopathic macular hole (MH) size is important because it is a major prognostic indicator of treatment success. Foveal pit morphologic features are highly symmetrical within individuals and may influence idiopathic MH size. Using a series of patients with unilateral idiopathic MHs, we examined the foveal floor size of the fellow eye to evaluate its relationship with idiopathic MH size and postoperative outcomes. Retrospective observational study. Two hundred forty-one participants with a unilateral idiopathic MH treated with surgery and a fellow eye with no ocular pathologic features. Both eyes underwent spectral-domain (SD) OCT imaging at the time of surgery. Minimum linear diameter (MLD) and base diameter (BD) defined idiopathic MH size. Foveal floor width (FFW) and minimal foveal thickness defined foveal pit morphologic features of the fellow eye. Baseline characteristics, SD OCT measurements, and preoperative variables were compared to determine their relationship with idiopathic MH size and postoperative visual acuity (VA) in logarithm of the minimum angle of resolution units. Foveal floor width was correlated with MLD (r= 0.36; P ≤ 0.001) and BD (r= 0.30; P ≤ 0.001), but not postoperative VA. Minimum linear diameter correlated with preoperative VA (r= 0.49; P ≤ 0.0001) and postoperative VA (r= 0.54; P ≤ 0.0001). A 2-stage regression model was developed to predict postoperative VA (r2= 0.28): preoperative VA (β= 0.36; P= 0.002) explained 13% of variability and MLD (β= 0.29; P= 0.002), and idiopathic MH duration (β= 0.23; P= 0.004) explained a further 16%. Foveal floor width of the fellow eye in patients with a unilateral idiopathic MH was correlated significantly with idiopathic MH size and may explain some of the variability in idiopathic MH size observed between individuals. However, FFW could not predict postoperative vision.

DEVELOPMENT OF IDIOPATHIC MACULAR HOLE IN FELLOW EYES: Spectral Domain Optical Coherence Tomography Features.

To investigate the long-term incidence and risk factors of macular hole (MH) development in the fellow eyes of patients with unilateral idiopathic MH. The retrospective case-control study involved the fellow eyes of 215 consecutive patients with idiopathic MH. The patients were classified into two groups according to the presence or development of MH in the fellow eye. The spectral domain optical coherence tomography features and clinical characteristics of each group were compared. Twelve (5.6%) patients presented with bilateral MH at the initial visit, whereas 20 (9.3%) initially unilateral patients developed MH in the fellow eye over a median interval of 44 months. Vitreomacular traction and inner foveal cyst were noted more frequently in the baseline spectral domain optical coherence tomography scans of fellow eyes of the bilateral group (P < 0.01). An outer foveal defect was found in five patients (35.7%) of the bilateral MH group (P < 0.01). The incidence of MH in fellow eyes was approximately 10%. The presence of outer foveal defect, inner foveal cyst, and vitreomacular adhesion or traction on spectral domain optical coherence tomography in the fellow eye was the risk factor for MH.

Vision-related parameters that affect stereopsis in patients with macular hole

This study evaluated stereopsis and other visual functions in patients with idiopathic macular hole (MH), and sought to identify vision-related parameters that affect stereopsis. In this prospective, consecutive, comparative study, 39 eyes of 39 patients with unilateral idiopathic MH were included. At baseline and at 6 months after MH surgery, we evaluated stereopsis, with the Titmus stereo test (TST) and TNO stereotest (TNO), best-corrected visual acuity (BCVA), letter contrast sensitivity, severity of metamorphopsia, as assessed using M-CHARTS, and extent of aniseikonia, by the new aniseikonia test. Preoperative stereopsis (log) in patients with MH were 2.72 ± 0.53 (range 1.9–4.1) in the TST and 2.82 ± 0.65 (range 1.8–3.9) in the TNO. Preoperative TST was significantly correlated with letter contrast sensitivity (p < 0.05), but not with the other visual functions. TNO showed significant correlation with letter contrast sensitivity (p < 0.05) and aniseikonia (p < 0.005). Preoperative TNO was associated with aniseikonia by multivariate analysis (p < 0.005). MH surgery significantly improved stereopsis, BCVA, letter contrast sensitivity, metamorphopsia, and aniseikonia. Postoperative TST and TNO was significantly associated with BCVA by multivariate analysis. Deterioration of stereopsis in MH patients is associated with contrast sensitivity and the degree of aniseikonia.

Preliminary observation of choroidal capillary flow area and density in patients with idiopathic macular hole before and after surgery

Objective To observe the changes of choroidal capillary flow area (CBFA) and density in patients with idiopathic macular hole (IMH) before and after surgery. Methods A prospective clinical study. Thirty patients (60 eyes) with unilateral IMH diagnosed in Department of Ophthalmology of The Second Hospital of Hebei Medical University from February 2017 to March 2018 and 30 age-and sex- matched normal controls were included in this study. All eyes were divided into group A (30 affected eyes), group B (30 fellow eyes) and group C (30 normal eyes of controls). Among 30 eyes in group A, there were 5, 14, 11 eyes with hole in stage Ⅱ, Ⅲ, Ⅳ, respecitvely. The eyes in group A were divided into two subgroups according to the diameter of the holes: group D: hole diameter less than or equal to 500 μm (11 eyes), group E: hole diameter over than 500 μm (19 eyes). All eyes in group A underwent vitrectomy. Spectral-domain OCT was used to observe the diameter size of macular hole and the closure of the hole after vitrectomy in eyes of group A. The CBFA and blood flow density of superficial choroidal capillaries were measured by OCT angiography before and 3 months after vitrectomy in groups A, B and C. Univariate analysis of variance and t test were used for statistical analysis. Results Before surgery, in group A, B and C, the CBFA were 2.84±0.35, 3.19±0.23, 3.26±0.24 mm2, the blood flow density were (20.74±8.26)%, (35.18±5.20)%, (35.20±6.49)%, respectively. The CBFA and blood flow density in group A were significantly lower than those in group B and C (F=19.768, 45.583; P = 0.000, 0.000), but there was no significant difference between group B and C (F=19.768, 45.583; P=0.332, 0.994). The CBFA and blood flow density in group D were higher than those in group E (t=2.230, 2.202; P=0.034, 0.036). The diameter of macular hole was negatively correlated with CBFA and blood flow density (r=-0.377, -0.477; P=0.044, 0.009). Three months after surgery, the macular holes in group A were closed; CBFA and blood flow density in macular area were significantly higher than before surgery (t=-4.126, -4.912; P=0.000, 0.000). Conclusions CBFA and blood flow density decreased in the macular area of IMH. CBFA and blood flow density can be recovered after vitrectomy. Key words: Retinal perforations/diagnosis; Tomographyoptical coherence; Regional blood flow; Choroidal capillary flow area

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.

Evaluation of Ganglion Cell-Inner Plexiform Layer Thickness after Vitreoretinal Surgery with Internal Limiting Membrane Peeling in Cases with Idiopathic Macular Hole.

Objectives:To evaluate macular retinal ganglion cell-inner plexiform layer (GCIPL) thickness after vitrectomy with internal limiting membrane (ILM) peeling for idiopathic macular holes using spectral domain optical coherence tomography (SD-OCT).Materials and Methods:Eighteen eyes of 18 patients with unilateral idiopathic macular hole who underwent vitrectomy with ILM peeling were retrospectively analyzed. Healthy fellow eyes of the patients and 18 eyes of 18 age-matched healthy individuals constituted the control group. The patients were evaluated at 1 day, 1 week, 1 month, and 3 months after surgery. The best corrected visual acuity (BCVA) measurements, biomicroscopic examination findings and SD-OCT measurements were recorded. Ganglion cell-inner plexiform layer thickness was evaluated with ganglion cell analysis software of Cirrus HD-OCT before surgery and at 1 month and 3 months after surgery and compared with control groups. Presence of dissociated optic nerve fiber layer (DONFL) was evaluated with C-scan mode.Results:Of the 18 patients, 9 were male and 9 were female with a mean age of 65.6±5.6 (55-77) years. Preoperative BCVA was 0.75±0.19 logMAR, while it was 0.44±0.17 logMAR and 0.36±0.15 logMAR at postoperative 1 and 3 months, respectively (p<0.001). Postoperative mean GCIPL thickness was 66.33±17.28 µm. There was a correlation between mean GCIPL thickness and BCVA at postoperative 3 months (p<0.01). When compared with the control group, GCIPL thickness was significantly thinner in all quadrants of all patients at postoperative 3 months. Dissociated optic nerve fiber layer appearance was observed on C-scan in 13 of 18 eyes postoperatively. There was no correlation between the presence of DONFL and BCVA (p>0.05).Conclusion:Internal limiting membrane peeling during macular hole surgery may cause functional and/or structural changes that may be associated with visual acuity. Significant GCIPL thinning and DONLF appearance may occur postoperatively.

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.

Wider retinal artery trajectories in eyes with macular hole than in fellow eyes of patients with unilateral idiopathic macular hole.

PurposeTo determine whether the width of the retinal artery (RA) trajectory was associated with the presence of a macular hole (MH).MethodsA retrospective cross sectional case-control study was performed. The fundus photographs were rotated 90 degrees, and the coordinates of the best fit curve of the RA trajectory were determined automatically based on these plots using the ImageJ program. The converted coordinates were fit to a second degree polynomial (ax2/100 + bx + c) equation. The width and steepness of the RA trajectory, “a”, of the eyes with a MH eye were compared to that of the fellow eyes.ResultsOne hundred and ten eyes of 55 consecutive patients (30 women) with a unilateral MH and healthy fellow eyes were analyzed. The mean age was 64.9 years (range 47-81 years). The constant ‘a’ was significantly smaller in eyes with a MH than that of the fellow eyes (0.379 ± 0.094 vs 0.416 ± 0.121, P = 0.001, paired t test), indicating that the RA trajectory was wider in the MH eyes than in the fellow eyes. There was a significant correlation between the axial length and ‘a’ of the RA trajectory in the MH eyes (R = 0.273, P = 0.044) and in the fellow eyes (R = 0.356, P = 0.008; Spearman’s rank correlation coefficient).ConclusionsBecause eyes with a MH have a significantly wider and flatter RA trajectory, there may be greater traction on the fovea which is located between the RA arches. The causative role of this finding is still unclear.

Automatic identification of eyes at risk of developing idiopathic macular hole

AbstractPurpose To automatically identify eyes with increased risk of developing idiopathic macular hole (IMH). This is proposed based on the fact that fellow eyes from patients with unilateral IMH have a risk increased by up to 29% of developing IMH. Our hypothesis is that there are changes in the topography of the macula that can allow the identification of these eyes prior to the development of IMH.Methods High‐resolution OCT scans from eyes at risk and control patients are acquired using the Cirrus HD‐OCT (Carl Zeiss Meditec, Dubin, CA, USA), Topcon 3D OCT (Topcon Medical Systems, Inc., Oakland, NJ, USA), and Spectralis HRA+OCT (Heidelberg Engineering GmbH, Heidelberg, Germany). From the volumetric scans, topographic maps are built from the segmentation of the inner limiting membrane and the retinal pigment epithelium. Parameters are extracted by fitting the maps to a set of bidimensional functions and from radial profiles of the region of interest. These are used to train a support vector machine (SVM), an automatic classification system. Optimizations to the system are ran in order to achieve the highest accuracy possible.Results Forty‐nine eyes with increased risk of IMH development (age: 67.4+‐5.5 yrs) and 44 control eyes (age: 58.5 +‐ 10.2) were imaged. The accuracy of the optimized SVM was 82.8%, sensitivity 85.7%, specificity 79.5%, assessed by 10‐fold cross‐validation.Conclusion The achieved results support our working hypothesis ‐ that structural changes are present well before being visible at a regular consultation.

Long-Term Observation of the Vitreomacular Relationship in Normal Fellow Eyes of Patients with Unilateral Idiopathic Macular Holes

Purpose: To describe long-term changes in the vitreomacular relationship in normal fellow eyes of patients with unilateral idiopathic macular holes (MHs). Methods: This is a retrospective, observational case series. The medical records of patients who underwent surgery for idiopathic MHs between May 2000 and December 2010 were reviewed. Patients who had clinically normal fellow eyes and underwent 12 months or more of follow-up were included. The vitreomacular relationship in the fellow eyes was evaluated using optical coherence tomography (OCT) and slit-lamp biomicroscopy. Results: The study included 153 patients with a mean age of 65.5 years and a mean follow-up of 33.5 months (range, 12-121). The incidence of vitreomacular attachments evaluated by OCT was 52% (80 eyes) at initial examination, which decreased to 41, 37 and 23% at 1, 2 and 3 years after the initial examination, respectively. Of the 80 eyes with vitreomacular attachments at initial examination, 40 (50%) still had vitreomacular attachments at the final visit. Of the remaining 40 eyes in which vitreomacular separation occurred during follow-up, 11 (28%) developed an MH, with a mean interval of 45 months. None of the eyes with vitreomacular separation at presentation developed an MH. Conclusion: This largest series of fellow eyes of MHs followed by OCT shows that, at presentation, about half of the patients already have premacular vitreous detachment and therefore no risk of MH, and that second MH develops in about 30% in the process of vitreomacular separation, which evolves over a prolonged period.

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.

片眼黄斑円孔症例の抑制と立体視－単眼視下と両眼視下での暗点の比較－

片眼黄斑円孔症例の抑制と立体視－単眼視下と両眼視下での暗点の比較－