Correlations between Visual Performance and Chorioretinal Variables after Vitrectomy for the Idiopathic Macular Hole

Abstract

Purpose: To investigate the relationships between visual function and the retinal and choroid microstructure in idiopathic macular hole patients after surgery.

Methods: A prospective study investigated changes in the fundus structure and visual function in 16 macular hole patients before and after surgery. Patients' best-corrected visual acuity (BCVA) and retinal sensitivity were measured by an EDTRS visual chart and microperimetry (MP1), respectively. The thickness of the retina and the blood supply to the retina and superficial choroid were detected by OCTA, and the choroidal capillary blood flow density was analysed with MATLAB. The thickness of the choroid and the aperture size of the macular hole were detected by Heidelberg OCT.

Results: Compared with before surgery and one month after surgery, the BCVA (3 months: 0.47 ± 0.27, before: 1.02 ± 0.22, 1 month: 0.66 ± 0.27, and P < 0.05) and the central sensitivity of the retina (3 months: 14.88 ± 2.87 dB, before: 8.76 ± 3.27 dB, 1 month: 12.22 ± 3.30 dB, and P < 0.05) were significantly improved three months after surgery. The change in BCVA was significantly correlated with the basal diameter (r = 0.677 and P = 0.004), the minimum diameter (r = 0.585 and P = 0.017), the macular hole cystoid height area index (r = -0.618 and P = 0.011), the central macular hole index (r = -0.727 and P = 0.001), the peripheral macular hole index (r = -0.758 and P = 0.001), the central tractional hole index (r = -0.717 and P = 0.002), the peripheral tractional hole index (r = -0.725 and P = 0.001), and changes in the peripheral blood vessel density of the choroid capillary layer (r = 0.585 and P = 0.0017). The change in central retinal sensitivity was correlated with the change in the superficial foveal avascular zone (FAZ; r = 0.520 and P = 0.039), change in the retinal superficial peripheral blood flow density (r = -0.503 and P = 0.047), change in the deep FAZ (r = 0.599 and P = 0.014), and change in the retinal deep peripheral blood flow density (r = -0.601 and P = 0.014).

Conclusions: The morphology of the macular hole as well as changes to the retinal and choroidal microstructure contributes to the recovery of visual function after surgery.

Figure 1

The minimum diameter, base diameter, and choroidal thickness (the choroidal thickness included nine positions: the subfoveal choroidal thickness and eight other superior, inferior, nasal, and temporal positions about 1 mm and 3 mm below the fovea) were measured.

Figure 2

The blood flow areas of the outer retinal layer and choroid capillary layer.

Figure 3

The full thickness of the retina and the blood flow density of the superficial retinal capillaries.

Figure 4

The retinal superficial or deep capillaries, the FAZ, and the choroidal blood vessel superficial capillary density (in the 0–0.6 mm, 0.6–1.5 mm, 1.5–2.0 mm, 2.0–2.5 mm, and 0.6–2.5 mm diameter areas).

Figure 5

Correlation analysis between the change in the peripheral blood vessel density of the choroid capillary layer and the morphology of the macular hole, (a) correlation between the change in the peripheral blood vessel density of the choroid capillary layer and the basal diameter, (b) correlation analysis between the change in the peripheral blood vessel density of the choroid capillary layer and the CMHI, and (c) correlation analysis between the change in the peripheral blood vessel density of the choroid capillary layer and the PMHI).