Pecaku Aurora, Melo Isabela Martins, Cao Jessica A, Sabour Shiva, Naidu Sumana C, Demian Sueellen, Popovic Marko M, Wykoff Charles C, Govetto Andrea, Muni Rajeev H
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
Retina Consultants of Texas, Houston, Texas.
Ophthalmol Retina. 2025 Apr;9(4):305-313. doi: 10.1016/j.oret.2024.10.018. Epub 2024 Oct 24.
To describe the sequential morphological changes of the outer retina after full-thickness macular hole (FTMH) formation utilizing a novel, objective staging system based on OCT, and to determine its association with baseline visual acuity, duration of symptoms, and postoperative visual acuity at 3 months.
Retrospective, observational, multicenter study.
Patients with idiopathic FTMH presenting to St. Michael's Hospital, Toronto, Canada, and Retina Consultants of Texas, Houston, Texas from 2009 to 2022.
The medical charts of 1000 patients with FTMH were reviewed, and those with ≥2 preoperative spectral-domain OCTs (SD-OCTs) were analyzed. A staging system was developed by assessing outer retinal morphology on successive SD-OCT central foveal scans.
Sequential outer retinal morphological changes with SD-OCT over time and their association with baseline visual acuity, duration of symptoms, and postoperative functional outcomes.
Fifty-two eyes of 52 patients with a mean age of 65.4 ± 8.4 years were included. Sequential outer retinal morphologic changes at the FTMH borders occurred in 4 distinct and reproducible stages: stage A, separation of the neurosensory retina from the retinal pigment epithelium with the well-defined external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (4/52, 7.7%); stage B, thickening of the EZ (27/52, 52.0%); stage C, patchy (moth-eaten) photoreceptor loss (16/52, 30.7%); and stage D, severe or complete loss of inner and outer segments and bare ELM (5/52, 9.6%). When assessing the preoperative OCT scans closest to the time of surgery, over a mean follow-up period of 288.9 ± 350.4 days (range, 5-1841), 28.85% (15/52) of eyes were in stage B, 28.85% (15/52) were in stage C, and 42.3% (22/52) were in stage D. There was a statistically significant association between increasing stage at baseline and longer duration of macular hole symptoms (P = 0.032) and worse visual acuity at baseline (P < 0.001). Additionally, patients presenting with stages B and C at the time point closest to surgery had better visual acuity outcomes 3 months postoperatively than those with stage D (P = 0.04).
This SD-OCT staging system describes the sequential in vivo morphologic changes after FTMH formation, providing a novel imaging biomarker.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
利用基于光学相干断层扫描（OCT）的新型客观分期系统，描述全层黄斑裂孔（FTMH）形成后视网膜外层的连续形态学变化，并确定其与基线视力、症状持续时间及术后3个月视力的相关性。
回顾性、观察性、多中心研究。
2009年至2022年期间就诊于加拿大多伦多圣迈克尔医院和美国得克萨斯州休斯敦得克萨斯视网膜咨询公司的特发性FTMH患者。
回顾了1000例FTMH患者的病历，并对术前有≥2次光谱域OCT（SD-OCT）检查结果的患者进行分析。通过评估连续SD-OCT中心凹扫描的视网膜外层形态，制定了一个分期系统。
随时间推移SD-OCT显示的视网膜外层连续形态学变化及其与基线视力、症状持续时间和术后功能结果的相关性。
纳入52例患者的52只眼，平均年龄65.4±8.4岁。FTMH边缘视网膜外层的连续形态学变化分为4个不同且可重复的阶段：A期，神经感觉视网膜与视网膜色素上皮分离，外部限制膜（ELM）、椭圆体带（EZ）和指状交叉带清晰（4/52，7.7%）；B期，EZ增厚（27/52，52.0%）；C期，散在（虫蚀状）光感受器缺失（16/52，30.7%）；D期，内、外节严重或完全缺失，仅存ELM（5/52，9.6%）。在评估最接近手术时间的术前OCT扫描时，平均随访288.9±350.4天（范围5-1841天），28.85%（15/52）的眼处于B期，28.85%（15/52）处于C期，42.3%（22/52）处于D期。基线分期增加与黄斑裂孔症状持续时间延长（P=0.032）及基线视力较差（P<0.001）之间存在统计学显著相关性。此外，在最接近手术时间点处于B期和C期的患者术后3个月的视力结果优于D期患者（P=0.04）。
该SD-OCT分期系统描述了FTMH形成后视网膜外层的连续体内形态学变化，提供了一种新的成像生物标志物。
在本文末尾的脚注和披露中可能会发现专有或商业披露信息。
