Macular hole closure patterns: an updated classification
| Autor: | Tommaso Rossi, Serena Telani, Guido Ripandelli, Nicole Koulisis, Daniela Bacherini, Stavros N. Moysidis, Danilo Iannetta, Stanislao Rizzo, Tamer H. Mahmoud, Tomaso Caporossi |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
030103 biophysics medicine.medical_specialty Fovea Centralis Visual acuity genetic structures Closure (topology) Spectral domain Basement Membrane 03 medical and health sciences Cellular and Molecular Neuroscience chemistry.chemical_compound 0302 clinical medicine Optical coherence tomography Foveal Ophthalmology Vitrectomy medicine Retrospective analysis Humans Macular hole Retrospective Studies medicine.diagnostic_test business.industry Retinal medicine.disease Retinal Perforations Sensory Systems chemistry 030221 ophthalmology & optometry medicine.symptom business Tomography Optical Coherence |
| Zdroj: | Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. 258(12) |
| ISSN: | 1435-702X |
| Popis: | The classification of macular hole closure patterns (MHCPs) currently relies on time domain OCT allowing only “open” and “closed” statuses or is based on inner foveal contour shape. Both classification types give no information on retinal layer reconstitution. Novel sophisticated surgical techniques lead to previously unknown MHCPs, outdating existing classifications and urging new ones. The purpose of the present study is to introduce a new classification allowing proper description of all MHCPs resulting from newer surgeries and based on the restoration of retinal layers. Retrospective analysis of patients undergoing MH surgery with five different surgical techniques was performed. MHCPs were classified according to spectral domain optical coherence tomography (SD-OCT). Type 0: open MH (0A: flat margin, 0B: elevated, 0C: oedematous); type 1: closed MHs (1A: reconstitution all retinal layers; 1B interruption of the external layers; 1C interruption of internal layers); type 2: MH closed with autologous or heterologous filling tissue interrupting the normal foveal layered anatomy (2A: filling tissue through all layers; 2B reconstitution of normal inner retinal layers; 2C reconstitution of normal outer retinal layers; 2D H-shaped bridging of filling tissue). Closure rate was 95.2% (241/253). Surgical technique and vision correlated to closure pattern (p < 0.001). Type 1 MHCPs had the best post-operative visual acuity (VA) compared with type 2 and type 0 (p < 0.001). MHCPs 1A and 1C performed better than all others. MHCP at months 1 and 3 changed in 42/254 (16.5%) and remained stable in 212/254 (83.5%). Improvement in vision was higher in eyes with shifting closure pattern (0.57 ± 0.33 vs 0.51 ± 0.48 logMAR; p 0.021). MHCP classification based on retinal layer restoration properly comprises post-operative anatomic morphologies. MHCPs correlate the surgical technique and post-operative visual outcomes. |
| Databáze: | OpenAIRE |
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