Idiopathic macular holes and direction of vitreomacular traction: Structural changes and surgical outcomes
Journal
Eye (Basingstoke)
Journal Volume
31
Journal Issue
12
Pages
1689-1696
Date Issued
2017
Author(s)
Abstract
PurposeTo compare the structural changes, clinical course, and treatment outcomes of vertical and horizontal vitreomacular traction (VMT) induced impending macular holes (IMHs) and full-thickness macular holes (FTMHs).MethodsIn this retrospective study, 23 and 32 cases of IMHs and FTMHs, respectively, were analyzed. The IMH cases were divided into two subgroups: IMH with and without foveal detachment. Vitreofoveal traction angles (TAs) between the inner retinal surface and posterior hyaloid were measured from horizontal and vertical optical coherence tomography (OCT) images by using the trigonometric function (the angle equals the arctangent of the height over the base) after adjustments for magnification factors. The largest angle was defined as the vitreomacular TA for the examined case. The critical angle - the TA differentiating cases with (vertical traction) or without (horizontal traction) foveal detachment (vertical traction) - was determined using regression analysis. Pretreatment and posttreatment OCT images, clinical courses, and treatment outcomes were compared between the two groups.ResultsThe critical angle was 27.2°. Cases of vertical traction had higher foveal height in the IMH group and wider bases in the FTMH group (P<0.05 respectively). IMHs with vertical traction had greater VM attachment than those with horizontal traction. In the FTMH group, postoperative visual improvement was lower (P=0.002); in the vertical traction group, inner segment:outer segment defects persisted longer (P=0.02).ConclusionsThe critical angle separating vertical from horizontal traction was 27.2°. Vertical VMT results in greater foveal structural changes in IMHs and possibly less favorable surgical outcomes in FTMHs. ? 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved.
SDGs
Other Subjects
adult; aged; Article; best corrected visual acuity; comparative study; controlled study; disease course; female; follow up; horizontal vitreomacular traction angle; human; idiopathic disease; idiopathic full thickness macular hole; idiopathic induced impending macular hole; major clinical study; male; middle aged; optical coherence tomography; photoreceptor inner segment; postoperative period; prognosis; retina detachment; retina fovea; retina macula hole; retina macula lutea; retinal pigment epithelium; retrospective study; treatment outcome; vertical vitreomacular traction angle; visual system parameters; vitrectomy; pathology; pathophysiology; procedures; retina macula lutea; retina tear; time factor; visual acuity; Aged; Female; Follow-Up Studies; Humans; Macula Lutea; Male; Middle Aged; Retinal Perforations; Retrospective Studies; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Visual Acuity; Vitrectomy
Publisher
Nature Publishing Group
Type
journal article