Офтальмохирургия (Oct 2015)
PREDICTING THE RESULTS OF SURGICAL TREATMENT OF IDIOPATHIC MACULAR HOLE
Abstract
Purpose. To determine structural and functional parameters the most informative in predicting the anatomic effect of surgical treatment of idiopathic macular hole (IMH).Material and methods. Using the spectral-domain optical coherence tomography (SD-OCT) we examined 165 patients (173 eyes) before and after surgery for the IMH. Possible prognostic parameters were determined by the ROC-analysis and stepwise discriminant analysis in the study group (111 patients, 118 eyes) and were evaluated retrospectively in a test group (54 patients, 55 eyes).Results. The most informative prognostic indicator was the average thickness of the retina in the foveal zone (AUC 0.935; at a fixed specificity of 95%: sensitivity – 54.5% and a threshold value for prediction of unfavorable outcome of the operation – ≤295 μm). Among other generally accepted prognostic criteria only tractional hole index had though lower, but not significantly different rates (0.793, 45.5%, ≤0.740 respectively, P> 0.05). At the threshold value ≤295 μm the average thickness of the retina in the foveal zone, showed sensitivity of 55% (6 out of 11 cases) and specificity of 94% (101 out of 107 cases) in the study group; the sensitivity of 57% (4 out of 7 cases) and a specificity of 90% (43 out of 48 cases) in a test group.Conclusion. The SD-OCT allows not only to obtain the detailed information on the structure of the IMH, but to predict with sufficient accuracy the outcomes of the intervention (performed by an experienced surgeon using modern technology). Along with the previously proposed criteria, the average thickness of the retina in the foveal zone is a new, highly informative criterion for the prediction of the anatomical effect of surgical treatment of the IMH, surpassing most other prognostic criteria.
