Li Yanting, Chen Bin, Chen Xinzhu, Lu Yunfeng
Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Shizi Street 188, Suzhou, Jiangsu Province, 215000, China.
Department of Ophthalmology, Suzhou EENT Hospital, Suzhou, Jiangsu Province, 215000, China.
BMC Ophthalmol. 2025 Apr 7;25(1):179. doi: 10.1186/s12886-025-03998-w.
Herein, we developed a new index called the drawbridge index to predict surgical outcomes and assessed its value in guiding surgical decision-making for large macular holes (MHs) with diameters of 400-550 μm.
A total of 48 eyes with large MHs (diameters of 400 to 550 μm), which had undergone vitrectomy with internal limiting membrane (ILM) peeling, were included and retrospectively analyzed. Based on optical coherence tomography images, base diameter, minimum linear diameter, the macular hole index (MHI), diameter hole index (DHI), and traction hole index (THI) were measured and calculated. The drawbridge index was calculated using the software ImageJ. It was determined by calculating the sum of the arm lengths extending from the break point of the outer plexiform layer (OPL) to the retinal pigment epithelium (RPE) on both sides of the macular hole, as well as the sum of the lengths from the starting point of the distorted OPL to the RPE in the vertical direction, and the difference between them then dividing by base diameter. The effectiveness of these predictive indices in prognosing "closed" versus "not closed" outcomes, and their correlation with outcome indicators, including best-corrected visual acuity, central foveal thickness, and ellipsoid zone defect length, was assessed. Furthermore, the area under the receiver operating characteristic curve (AUC) and a cutoff value were calculated for the drawbridge index. In the second part, a total of 21 patients were enrolled in the validation group, and the drawbridge index was utilized to guide surgical decisions for the ILM techniques.
Significant differences were observed between the "closed" and "not closed" groups using the drawbridge index (P < 0.05). The drawbridge index was significantly correlated with postoperative best-corrected visual acuity, ellipsoid zone defect, and central foveal thickness. It exhibited an AUC value of 0.92, and the cutoff value of 1.03 demonstrated a sensitivity of 87.50% and a specificity of 80.00%. Assisted by the drawbridge index, a 100% closure rate was achieved in patients in the validation group.
The drawbridge index may be reliable and useful for making surgical decisions regarding ILM manipulation for large MHs.
在此，我们开发了一种名为吊桥指数的新指标来预测手术结果，并评估其在指导直径为400 - 550μm的大黄斑裂孔（MH）手术决策中的价值。
纳入48只接受了玻璃体切除术联合内界膜（ILM）剥除的大MH（直径400至550μm）眼，并进行回顾性分析。基于光学相干断层扫描图像，测量并计算基底部直径、最小线性直径、黄斑裂孔指数（MHI）、直径裂孔指数（DHI）和牵引裂孔指数（THI）。使用ImageJ软件计算吊桥指数。它是通过计算从黄斑裂孔两侧外丛状层（OPL）断点延伸至视网膜色素上皮（RPE）的臂长总和，以及从扭曲的OPL起点到垂直方向RPE的长度总和，然后将它们的差值除以基底部直径来确定的。评估这些预测指标在预测“闭合”与“未闭合”结果方面的有效性，以及它们与包括最佳矫正视力、中心凹厚度和椭圆体带缺陷长度等结果指标的相关性。此外，计算吊桥指数的受试者操作特征曲线（AUC）下面积和截断值。在第二部分，21例患者纳入验证组，使用吊桥指数指导ILM技术的手术决策。
使用吊桥指数在“闭合”组和“未闭合”组之间观察到显著差异（P < 0.05）。吊桥指数与术后最佳矫正视力、椭圆体带缺陷和中心凹厚度显著相关。其AUC值为0.92，截断值1.03的敏感性为87.50%，特异性为80.00%。在吊桥指数的辅助下，验证组患者实现了100%的闭合率。
吊桥指数对于大MH的ILM操作手术决策可能是可靠且有用的。
