Manchester Manchester Royal Eye Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.
Retina. 2023 Mar 1;43(3):464-471. doi: 10.1097/IAE.0000000000003680.
To quantify the rate of idiopathic macular hole progression from presentation and identify factors that may influence stratification and urgency for surgical listing based on the initial optical coherence tomography scans.
The minimal linear diameter (MLD), base diameter (BD), and hole height on nasal and temporal sides of idiopathic macular hole were measured on spectral domain optical coherence tomographies, on initial presentation and just before surgery. Mean hole height, hole height asymmetry (absolute difference between nasal and temporal height), MLD/BD, and MLD change per day (MLD/day) were calculated for each patient. Multivariable linear regression analysis with MLD/day as the dependent variable was performed to identify significant risk factors for MLD progression. Minimal linear diameter was grouped to quintiles: 1: ≤290 µ m, 2: >290 µ m and ≤385 µ m, 3: >385 µ m and ≤490 µ m, 4: >490 µ m and ≤623 µ m, and 5: >623 µ m.
In 161 eyes (157 patients), we report significant associations with MLD/day: 1) MLD/BD ( P = 0.039) (i.e., wide BD relative to MLD lead to faster progression of MLD), 2) hole height asymmetry ( P = 0.006) (larger absolute difference between nasal and temporal hole height lead to faster progression), and 3) days between scans ( P < 0.001) (longer duration between scans had reduced MLD/day, indicating more rapid increase initially then plateaux), and relative to MLD Quintile 1, MLD Quintile 3 ( P = 0.002) and MLD Quintile 4 ( P = 0,008), and MLD Quintile 5 ( P < 0.001) all lead to a reduced MLD/day rate on multivariable regression.
In addition to finding that the previously reported initial smaller MLD is a risk factor for rapid MLD progression, we report two novel findings, large hole height asymmetry and a low MLD/BD (wide base relative to MLD), that represent significant risk factors. These factors should be taken into consideration on presentation to stratify timing of surgery.
从表现上量化特发性黄斑裂孔进展的速度，并确定可能影响手术列表分层和紧迫性的因素，这些因素基于初始光相干断层扫描。
在特发性黄斑裂孔的初始呈现和手术前，通过光谱域光相干断层扫描测量最小线性直径（MLD）、基底直径（BD）和鼻侧和颞侧的裂孔高度。为每个患者计算平均裂孔高度、裂孔高度不对称（鼻侧和颞侧高度的绝对差异）、MLD/BD 和 MLD 每日变化（MLD/天）。使用 MLD/天作为因变量进行多变量线性回归分析，以确定 MLD 进展的显著危险因素。MLD 分为五组：1：≤290µm，2：>290µm 和≤385µm，3：>385µm 和≤490µm，4：>490µm 和≤623µm，5：>623µm。
在 161 只眼（157 例患者）中，我们报告了与 MLD/天显著相关的因素：1）MLD/BD（P=0.039）（即，BD 相对于 MLD 较宽会导致 MLD 更快地进展），2）裂孔高度不对称（P=0.006）（鼻侧和颞侧裂孔高度的绝对差异越大，进展越快），3）扫描之间的天数（P<0.001）（扫描之间的时间越长，MLD/天越低，表明最初的增长较快，然后达到平台期），与 MLD 五分位 1 相比，MLD 五分位 3（P=0.002）和 MLD 五分位 4（P=0.008），以及 MLD 五分位 5（P<0.001），在多变量回归中都导致 MLD/天的速度降低。
除了发现先前报道的初始较小的 MLD 是快速 MLD 进展的危险因素外，我们还报告了两个新发现，即大的裂孔高度不对称和低的 MLD/BD（相对于 MLD 的宽基底），这是显著的危险因素。这些因素在呈现时应加以考虑，以分层手术的时间。
