Non-Invasive Retinal Imaging Modalities for the Identification of Prognostic Factors in Vitreoretinal Surgery for Full-Thickness Macular Holes

Abstract

In this review, we will focus on different non-invasive retinal imaging techniques that can be used to evaluate morphological and functional features in full-thickness macular holes with a prognostic purpose. Technological innovations and developments in recent years have increased the knowledge of vitreoretinal interface pathologies by identifying potential biomarkers useful for surgical outcomes prediction. Despite a successful surgery of full-thickness macular holes, the visual outcomes are often puzzling, so the study and the identification of prognostic factors is a current topic of interest. Our review aims to provide an overview of the current knowledge on prognostic biomarkers identified in full-thickness macular holes by means of different retinal imaging tools, such as optical coherence tomography, optical coherence tomography angiography, microperimetry, fundus autofluorescence, and adaptive optics.

Keywords: OCT; OCTA; biomarkers; full-thickness macular hole; prognostic factors; retinal imaging.

Figure 1

Preoperative parameters of full-thickness macular hole (FTMH) on Optical Coherence Tomography (OCT) scan. Minimum linear diameter (MLD), base diameter (BD), and hole height (H) are shown.

Figure 2

Optical Coherence Tomography (OCT) scans of full-thickness macular holes and defects in external limiting membrane (ELM), ellipsoid zone (EZ), and interdigitation zone (IZ) at baseline (A,C) and at six months follow-up (B,D). (A) Preoperative ELM, EZ and IZ are almost preserved and at postoperative follow-up (B) a quite full subfoveal restoration of the three bands can be appreciated. (C) Preoperative ELM, EZ and IZ defects are extensive and at postoperative follow-up (D) subfoveal atrophy development can be observed.

Figure 3

Optical Coherence Tomography (OCT) scan of a full-thickness macular hole associated with intraretinal cystoid spaces. Multiple hyporeflective cystoid spaces are located in both the inner nuclear layer and the outer nuclear layer.

Figure 4

Optical Coherence Tomography (OCT) scan showing photoreceptor outer segment disruption at the macular hole borders (arrowhead). Supra−retinal pigment epithelium hyperreflective granular deposits are also visible at the base of the hole (arrow).

Figure 5

(A) Optical coherence tomography (OCT) scan showing a full-thickness macular hole (FTMH) accompanied by atypical epiretinal tissue (arrowhead); (B) OCT scans showing a hyperreflective epiretinal membrane associated with FTMH (arrowhead).

Figure 6

Microperimetric sensivity map in a case of full-thickness macular hole: an absolute central scotoma is evident with a surrounding ring of relative scotoma.

Figure 7

Optical coherence tomography angiography maps of a full-thickness macular hole.

Figure 8

(A) Fundus autofluorescence (FAF) image of a full-thickness macular hole. FAF shows hyperautofluorescence in the macula. (B) Fundus photograph in the same eye. (C) Optical coherence tomography scan in the same eye.

Figure 9

(A) Fundus autofluorescence (FAF) image of a small full-thickness macular hole. FAF shows a very low hyperautofluorescence in the macula. (B) Fundus photograph in the same eye. (C) Optical coherence tomography scan in the same eye.

Figure 10

(A–D) Adaptive Optics images of cone mosaic (on the left part of the figure), with the estimation of cone density, in a full-thickness macular hole before and after surgery at different time points. Optical Coherence Tomography scans corresponding to the different adaptive optics images are depicted in the right part of the image.