JAN 18, 2012
This prospective study confirmed that use of spectral-domain optical coherence tomography (SD-OCT) can determine the status of a macular hole on postoperative day one even in gas-filled eyes. The study’s results, which were published in the December issue of Clinical and Experimental Ophthalmology, suggest that visibility depends on the volume of intravitreal gas and the absence of a posterior staphyloma.
The study included 26 consecutive eyes with an idiopathic macular hole, seven eyes with a macular hole retinal detachment (MHRD) and four eyes with a macular hole with myopic traction maculopathy. The macular area was examined by SD-OCT (OCT-4000) in the sitting position on postoperative days one, three, seven and 30. When a macular image could not be obtained, the patient was instructed to look slightly downward or upward until a clearer view of the macular area was visible in the OCT images.
When macular hole closure was confirmed, the face-down position was discontinued. However, patients were instructed to avoid a supine position for one to two weeks even after closure was detected.
Macular hole status was able to be assessed in 24 eyes (92 percent) on postoperative day one. Twenty-three holes were found to be closed. The other two eyes had a lower volume of gas (≤ 60 percent) than that in the 24 eyes (> 80 percent) with a visible macula. The macular hole of seven eyes could be seen only when the patients looked upward or downward (P = 0.009). Even though these eyes had gas volume of at least 80 percent on postoperative day one, a clear macular image could not be observed because the high reflection from the interface between the gas bubble and the retina decreased the retinal signal.
The 11 eyes with MHRD or a myopic traction maculopathy had a posterior staphyloma, and the macular hole was visible only in four of these eyes on day one (P = 0.001). In all eyes in which closure of the macular hole was detected on day one, the hole remained closed on day 30.
The authors suggest that the contact of the gas bubble with the macular area may determine the clarity of the macular image in gas-filled eyes. They also conclude that SD-OCT can be used to detect retinal detachment and retinischisis in gas-filled eyes with myopic traction maculopathy.