# Preoperative Optical Coherence Tomography Markers and Their Significance in the Treatment of Macular Holes Using the Inverted Internal Limiting Membrane Technique

## TL;DR

This study shows that the inverted flap technique is effective for treating macular holes, with the macular hole index predicting visual recovery.

## Contribution

The study identifies the macular hole index as a novel predictor of visual acuity outcomes after macular hole surgery.

## Key findings

- All patients achieved full closure of the macular hole after surgery.
- The macular hole index (MHI) was the only significant predictor of postoperative distance visual acuity.
- Twenty-four patients had large macular holes (≥400 µm), and twenty-two had small ones (<400 µm).

## Abstract

Purpose

The purpose of this study was to evaluate the short-term outcomes of pars plana vitrectomy (PPV) using the inverted flap technique for full-thickness macular hole (FTMH). Specifically, the study aimed to identify significant preoperative optical coherence tomography (OCT) parameters that can serve as predictors for postoperative distance and near best-corrected visual acuity (DBCVA and NBCVA).

Methods

A prospective analysis was conducted on patients diagnosed with FTMH who underwent PPV from September 2022 to November 2024 using the inverted flap technique. OCT imaging was conducted preoperatively and one month postoperatively. Parameters analyzed included base diameter (BD), height of the macular hole (HT), right arm length (RAL) of macular hole (MH), left arm length (LAL) of MH, macular hole index (MHI), diameter hole index (DHI), tractional hole index (THI), hole form factor (HFF) and central retinal subfield (CRS). Statistical analysis was conducted to calculate significant predictors for DBCVA and NBCVA short-term postoperative results after PPV, with statistical significance set at p<0.05.

Results

A total of 46 patients, 35 (76.1%) women and 11 (23.9%) men, aged 67.6±5.7 were included in the study. Means and standard deviation for analyzed parameters were BD=937.5±355 𝜇m, HD=424.6±188 𝜇m, HT=413.6±56.5 𝜇m, RAL=359.6±125.5 𝜇m, LAL=367.5±214 𝜇m, MHI=0.477±0.12, DHI=0.46±0.15, THI=1.2±0.71, HFF=0.79±0.17 and CRS=297.4±21.8 𝜇m. Twenty-four patients presented with large FTMH (≥400 µm), and twenty-two with small FTMH (<400 µm). All patients achieved full closure of the FTMH. The most common comorbidity was hypertension, with 13 patients (28.3%). The only statistically significant predictor of DBCVA change after surgery was MHI (p=0.01).

Conclusions

PPV surgery using the inverted flap technique has very high efficiency. MHI can be used in the prediction of postoperative DBCVA. Further research is needed to assess the role of THI and HFF as other predictors.