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Observational Study
. 2018 Mar;32(3):590-596.
doi: 10.1038/eye.2017.254. Epub 2017 Dec 8.

Measurement of full-thickness macular hole size using en face optical coherence tomography

E Philippakis  1 , M Legrand  1 , M El Sanharawi  1 , A Erginay  1 , A Couturier  1 , R Tadayoni  1
Affiliations
Observational Study

Measurement of full-thickness macular hole size using en face optical coherence tomography

E Philippakis et al. Eye (Lond). 2018 Mar.

Abstract

PurposeTo assess the feasibility and interest of measuring macular hole (MH) size using en face optical coherence tomography (OCT) compared with manual diameter measurements on B-scans.MethodsAmong our previously published series of 100 patients operated for primary MH, patients whose images were acquired with Cirrus 5000 HD-OCT (Carl Zeiss Meditec) with a quality signal strength >5/10 were included. Three segmentations (internal limiting membrane, horizontal, and retinal pigment epithelium (RPE)) were compared for obtaining the most appropriate en face image. MH surface areas were measured using ImageJ software. Mean diameters calculated from surface areas (diameter=2 × √(surface area/π)) were compared with those measured on B-scans.ResultsNineteen patients were included with a mean age of 72±8 years (56-86) and a female predominance (3/16). The mean absolute difference between horizontal and vertical diameters measured on B-scans was of 54±47 μm (0-180) without reaching significance (P=0.874). RPE segmentation provided the best en face image and was feasible without and with adjustment, respectively, in 79% and 100% (cases with vitreomacular traction) of cases. No significant difference in mean diameters was observed between those calculated from en face images (435±143 μm (195-693)) and those measured on horizontal B-scans (426±139 μm (214-705), P=0.482).ConclusionMeasuring MH size on en face OCT images is feasible, reliable, and eliminates the potential bias related to manual measurements on B-scans. Its integration into OCT devices would offer an automated and easy-to-use option for clinical practice.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Macular hole diameter measured on horizontal and vertical SD-OCT B-scans. The diameter is measured with a caliper as a line drawn roughly parallel to the retinal pigment epithelium, at the narrowest distance between the hole edges.
Figure 2
Figure 2
Possible segmentations in en face analysis on Cirrus 5000 HD-OCT. (a) Internal limiting membrane (ILM) slab segmentation. The line of the ILM does not follow the MH shape, and shows an eccentric pattern. As a result, the en face images obtained with the ILM segmentation show a hyperreflective annular area corresponding to the retinal pigment epithelium (RPE) and a hyporeflective spot corresponding to the remaining MH center. (b) Horizontal slab segmentation in the en face analysis does not align with the retinal shape, resulting in an unusable en face image. (c) RPE segmentation showing the inner line tangent to the ILM display, and the outer line delineating the RPE. En face images show a well-defined dark spot, suitable for surface area measurement.
Figure 3
Figure 3
Image processing and surface area measurement with ImageJ with adjustment of the threshold to minimum.
Figure 4
Figure 4
Measurement method using en face imaging from macular cube acquisitions to mean macular hole diameter.
See this image and copyright information in PMC

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