A novel index using optical coherence tomography for predicting anatomical and visual outcomes of idiopathic macular hole surgery

TL;DR

This study introduces a new OCT-based index, MHRI, to predict the success of macular hole surgery in terms of both anatomical and visual outcomes.

Contribution

The novel Macular Hole Reflectivity Index (MHRI) is proposed as a predictor for surgical and visual success in macular hole surgery.

Findings

MHRI was significantly lower in the surgical success group (p < 0.0001).

MHRI showed an AUC of 97.0% for predicting anatomical closure with a cutoff of 1.65.

MHRI had a 76.1% AUC for predicting visual success with a cutoff of 1.38.

Abstract

In this study, we introduced a new optical coherence tomography index, Macular Hole Reflectivity Index (MHRI), for macular hole surgery prognosis. Visual acuity improvement is unpredictable in macular hole surgery, and as the reflectivity of RPE can be a biomarker for the status of RPE, we aimed to evaluate the new index in terms of anatomical and visual outcomes.

A retrospective consecutive case series of 48 patients with idiopathic full-thickness macular hole (FTMH) who had undergone pars plana vitrectomy with inverted internal limiting membrane (ILM) flap was performed. To calculate the MHRI, the spectral domain optic coherence tomography (SD-OCT) images were converted into 8-bit greyscale images. The MHRI was defined as the ratio of Maximum central reflectivity / Minimum paracentral reflectivity. Analysis was performed to assess if the index was an independent predictor of post-operative VA, and the MHRI cutoffs were calculated based on the receiver operating characteristic curve (AUC) to evaluate the ability of indices to predict surgical and visual success.

The MHRI was significantly lower in the surgical success group (p < 0.0001). MHRI was significantly correlated with the postoperative VA. MHRI exhibited an AUC value of 97.0%, and the cutoff value of 1.65 demonstrated a sensitivity of 91% and a specificity of 100% for anatomical closure. The prognostic value of MHRI was further evaluated by analysis of those with successful surgical closure for visual success. The AUC for predicting visual success after FTMH surgery was 76.1%, with a cutoff value of 1.38.

MHRI demonstrated to be an efficient index in the prediction of anatomical and visual success in macular hole surgery. However, larger multicenter studies are required to validate the applicability and predictive value of this index in clinical settings.

Figures