Optical coherence tomography angiography features in patients with idiopathic full-thickness macular hole, before and after surgical treatment

Abstract

Purpose: To present optical coherence tomography (OCT) angiography features in patients with idiopathic full-thickness macular hole before and after vitrectomy.

Study design: Prospective case series study.

Materials and methods: Patients presenting with an idiopathic full-thickness macular hole (IMH) who underwent posterior vitrectomy with internal limiting membrane peeling and gas tamponade were included in the study. En face OCT and OCT angiography (OCTA) was performed pre- and postoperatively using 3×3 mm scans (Optovue, XR Avanti). Foveal avascular zone (FAZ) area, macular hole size (MHS), central retinal thickness (CRT), macular parafoveal choriocapillary flow area (MCFA), and fovea vessel density (FVDS) were measured and assessed using OCTA. Best-corrected visual acuity (BCVA) was examined before and 3 months after surgery.

Results: Twenty-eight eyes of 28 patients were included in the study. The mean age of patient group was 68.28 years. The hole was closed in all eyes after the initial surgery. OCTA showed enlargement of FAZ and increased CRT in foveal area. Mean preoperative FAZ area was 0.39±0.07 mm². En face images of the middle retina showed a range of preoperative cystic patterns surrounding the hole. BCVA was improved from 0.1±0.11 preoperatively to 0.42±0.17 postoperatively. Mean FAZ area was reduced to 0.24±0.07 mm² postoperatively with resolution of macular hole and adjacent cystic areas. Mean CRT was reduced from 396±62.6 µm pre-operatively to 272±30.7 µm postoperatively. After vitrectomy, the parafoveal choriocapillary flow area and FVDS of IMH eyes increased compared with the preoperative measurements.

Conclusion: Quantitative evaluation of vascular and morphological changes following IMH surgery using OCTA shows the potential for recovery due to vascular and neuronal plasticity. OCTA showing vascular changes and their quantitative characteristics might be a useful tool for the assessment of macular holes before and after surgical treatment.

Keywords: angio-OCT; central retinal thickness; choriocapillary flow area; foveal avascular zone; foveal vessel density; idopathic full thickness macular hole; imaging; vitrectomy.

Figure 1

Pre- and postoperative FAZ measurement using a nonflow software in an 82-year-old male patient. Note: FAZ decreased from 0.405 mm² preoperatively to 0.152 mm² postoperatively. Abbreviation: FAZ, foveal avascular zone.

Figure 2

The fovea vessel density (FVDS) measured in superficial capillary plexus (SCP) using a density function on the imaging software. Notes: In vascular density color perfusion maps, bright red represents a density of greater than 50% perfused vessels, dark blue represents no perfused vessels, and intermediate perfusion densities are color coded accordingly. In presented case example of 82-year-old male patient, the increase of FVDS from 29.83% to 38.73% after surgery is to observe. The ischemic areas decreased significantly. We observe a reduction of central retinal thickness from 531 to 253 µm postoperatively.

Figure 3

Pre- and postoperative choriocapillary flow area measurement using a flow tool of imaging software. Note: This example shows a case of 82-year-old male patient with an increase in choriocapillary flow area from 0.768 mm² preoperatively to 1.914 mm² postoperatively.

Figure 4

Pre- and post- operative OCTA of 82-year-old patient’s left eye. Notes: (A) Preoperative OCTA report of 82-year-old male patient’s left eye showing numerous cystic changes in middle retina in en face scans. Macular basal hole size is 2,146 µm, minimum hole diameter is 427 µm. BCVA preoperatively was 0.08. (B) Postoperative OCTA scans of the same case as presented above. We observe in OCTA and en face scans the resolution of macular hole and adjacent cystic areas with normalization of foveal morphology and reduction of central retinal thickness. BCVA improved to 0.3 after surgery. Abbreviations: BCVA, best-corrected visual acuity; OCT, optical coherence tomography; OCTA, optical coherence tomography angiography.

Figure 5

Pre- and post- operative OCTA of 75-year-old patient’s right eye. Notes: (A) Preoperative OCTA report of 75-year-old female patient’s right eye showing numerous cysts in middle retina in en face scans. Macular basal hole size is 1,565 µm, minimum hole diameter is 699 µm. BCVA preoperatively was 0.08. (B) Postoperative OCTA scans of the same patient as presented above. We observe in OCTA and en face scans the resolution of macular hole and adjacent cystic areas with reduction of central retinal thickness. BCVA improved to 0.4 after surgery. Abbreviations: BCVA, best-corrected visual acuity; OCT, optical coherence tomography; OCTA, optical coherence tomography angiography.

Figure 6

The r-Pearson correlation coefficient between the initial MHS and the BCVA. Notes: (A) Relationship between preoperative macular hole size (MHS) and best-corrected visual acuity (BCVA). (B) Relationship between preoperative MHS and macular parafoveal choriocapillary flow. (C) Relationship between preoperative FAZ and postoperative BCVA. (D) Relationship between postoperative BCVA and postoperative CRT. Abbreviations: CRT, central retinal thickness; FAZ, foveal avascular zone.