Cakir Yavuz, Sassine Antoine, Matar Karen, Amine Reem, Reese Jamie, Srivastava Sunil K, Ehlers Justis P
The Tony and Leona Campane Center for Excellence in Image-Guided Surgery and Advanced Imaging Research, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
J Vitreoretin Dis. 2024 Jul 28;8(5):558-564. doi: 10.1177/24741264241263172. eCollection 2024 Sep-Oct.
To explore opportunities for individualized postoperative positioning duration in macular hole (MH) surgery. : This post hoc analysis comprised eyes that had full-thickness MH (FTMH) repair in the prospective DISCOVER intraoperative optical coherence tomography (OCT) study. Preoperative spectral-domain OCT (SD-OCT) and postoperative day 1 (POD1) trans-tamponade OCT were analyzed. Preoperative SD-OCT macular cubes were imported and analyzed using a machine learning-enhanced segmentation platform. Nine preoperative segmentation parameters were analyzed (maximum foveal height, apex area, base area, central foveal area, maximum apex diameter, maximum base diameter, maximum depth, minimum foveal width, volume). In addition, 2 new metrics-the macular hole index and tractional hole index-were calculated. POD1 trans-tamponade OCTs were obtained and evaluated for hole closure. : Of the 66 eyes with an FTMH, 16 (24%) had a chronic MH and 5 (8%) were reoperations from FTMH nonclosure after previous surgery. Nine eyes (14%) had an open MH on POD1 trans-tamponade OCT (6 chronic MHs [66%]; 2 reoperations [22%]); the remaining 57 MHs (86%) were closed. Multiple segmentation parameters were significantly associated with POD1 closure. : Volumetric MH measurements and trans-tamponade POD1 OCT closure status are important in predicting MH closure speed and the need for postoperative positioning. Individualized positioning duration in MH could lower perioperative morbidity and vastly enhance quality of life.
探索黄斑裂孔（MH）手术中个性化术后体位维持时间的机会。：这项事后分析纳入了前瞻性DISCOVER术中光学相干断层扫描（OCT）研究中接受全层MH（FTMH）修复的眼睛。分析了术前光谱域OCT（SD-OCT）和术后第1天（POD1）经填塞物OCT。将术前SD-OCT黄斑区图像导入并使用机器学习增强分割平台进行分析。分析了9个术前分割参数（最大黄斑中心凹高度、裂孔顶部面积、底部面积、中心黄斑区面积、最大顶部直径、最大底部直径、最大深度、最小黄斑中心凹宽度、体积）。此外，还计算了2个新指标——黄斑裂孔指数和牵拉性裂孔指数。获取POD1经填塞物OCT图像并评估裂孔闭合情况。：在66只FTMH眼中，16只（24%）为慢性MH，5只（8%）为先前手术FTMH未闭合后的再次手术。9只眼（14%）在POD1经填塞物OCT检查时有开放的MH（6只慢性MH[66%]；2只再次手术眼[22%]）；其余57只MH（86%）闭合。多个分割参数与POD1时的闭合显著相关。：黄斑裂孔体积测量和POD1经填塞物OCT闭合状态对于预测MH闭合速度和术后体位需求很重要。MH手术中个性化的体位维持时间可降低围手术期发病率并极大提高生活质量。
