Clinical Interventions in Aging (Mar 2019)
Optical coherence tomography angiography features in patients with idiopathic full-thickness macular hole, before and after surgical treatment
Abstract
Tomasz Wilczyński,1 Anna Heinke,1 Agata Niedzielska-Krycia,1 Daria Jorg,2 Katarzyna Michalska-Małecka1,3 1University Clinical Center, University Hospital Medical University of Silesia, Katowice, Poland; 2Department of Sexuology, Woman’s Health Institute, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland; 3Department of Ophthalmology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland Purpose: To present optical coherence tomography (OCT) angiography features in patients with idiopathic full-thickness macular hole before and after vitrectomy. Study design: Prospective case series study. Materials and methods: Patients presenting with an idiopathic full-thickness macular hole (IMH) who underwent posterior vitrectomy with internal limiting membrane peeling and gas tamponade were included in the study. En face OCT and OCT angiography (OCTA) was performed pre- and postoperatively using 3×3 mm scans (Optovue, XR Avanti). Foveal avascular zone (FAZ) area, macular hole size (MHS), central retinal thickness (CRT), macular parafoveal choriocapillary flow area (MCFA), and fovea vessel density (FVDS) were measured and assessed using OCTA. Best-corrected visual acuity (BCVA) was examined before and 3 months after surgery. Results: Twenty-eight eyes of 28 patients were included in the study. The mean age of patient group was 68.28 years. The hole was closed in all eyes after the initial surgery. OCTA showed enlargement of FAZ and increased CRT in foveal area. Mean preoperative FAZ area was 0.39±0.07 mm2. En face images of the middle retina showed a range of preoperative cystic patterns surrounding the hole. BCVA was improved from 0.1±0.11 preoperatively to 0.42±0.17 postoperatively. Mean FAZ area was reduced to 0.24±0.07 mm2 postoperatively with resolution of macular hole and adjacent cystic areas. Mean CRT was reduced from 396±62.6 µm preoperatively to 272±30.7 µm postoperatively. After vitrectomy, the parafoveal choriocapillary flow area and FVDS of IMH eyes increased compared with the preoperative measurements. Conclusion: Quantitative evaluation of vascular and morphological changes following IMH surgery using OCTA shows the potential for recovery due to vascular and neuronal plasticity. OCTA showing vascular changes and their quantitative characteristics might be a useful tool for the assessment of macular holes before and after surgical treatment. Keywords: angio-OCT, imaging, idiopathic full thickness macular hole, vitrectomy, foveal avascular zone, central retinal thickness, choriocapillary flow area, foveal vessel density
