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. 2023 Nov 17;23(1):467.
doi: 10.1186/s12886-023-03187-7.

Predictive value of ellipsoid zone-related angle parameters in primary surgery of large macular hole: a case control study

Huaqin Xia #  1 , Jiarui Yang #  1   2 , Yi Ding  3 , Xinglin Wang  1 , Yanfeng Liao  1 , Yiwen Shi  1 , Hongliang Dou  4   5 , Xuemin Li  6   7
Affiliations

Predictive value of ellipsoid zone-related angle parameters in primary surgery of large macular hole: a case control study

Huaqin Xia et al. BMC Ophthalmol. .

Abstract

Background: To explore the predictive value of Ellipsoid Zone (EZ) -related angle parameters for the outcome of primary macular hole surgery.

Methods: This was a retrospective study. Patients diagnosed with large macular hole (MH) (minimum diameter > 500 μm) between 2018 and 2021 were enrolled. All patients underwent 25-gauge pars plana vitrectomy, internal limiting membrane (ILM) peeling and air tamponade. Spectral-domain OCT (SD-OCT) and best corrected visual acuity (BCVA) were measured in preoperative and 2-week post-operative. Classic and angle related parameters were measured via ImageJ. Angle regularity (AR) were defined as the standard deviation of the angle parameters in vertical and horizontal direction.

Results: Seventy-six eyes were included for analysis; 24 eyes showed an unclosed macular hole at the 2-week postoperative and 52 eyes showed a closed hole. Preoperatively, MLD (P < 0.001), BD (P = 0.009) and diameter of EZ/ELM disruption (P = 0.002 and 0.025) in patients failed to close the hole after primary surgery were significantly larger than those succeeded. EZ-MH (P = 0.018), EZ-NFL (P = 0.006), EZ-GCL (P = 0.004), EZ-INL (P = 0.002), EZ-OPL (P = 0.009) and EZ-ONL (P = 0.011) angles were smaller in patients with unclosed hole. AR of the EZ-NFL (P = 0.009), EZ-GCL (P = 0.009), EZ-OPL (P = 0.023), EZ-ONL (P = 0.048) and Basal-NFL (P = 0.030) angles among the unclosed patients were significantly larger than those of the closed group. EZ-NFL (P = 0.015), EZ-GCL (P = 0.004), EZ-INL (P < 0.001), EZ-OPL (P < 0.001), EZ-ONL (P < 0.001), Basal (P = 0.023) and Basal-NFL (P < 0.001) angles of hole-unclosed patients enlarged significantly after the surgery.

Conclusions: Patients with large macular holes and an increased EZ-related angle and angle AR are more likely to experience unsuccessful outcomes following primary MH surgery. Therefore, EZ-related angles hold potential as valuable parameters for predicting the surgical outcome.

Keywords: Ellipsoid zone; Macular hole; Vitrectomy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of case selection
Fig. 2
Fig. 2
Diagrams showing the angles measured. a ① Minimal linear diameter, MLD; ② Basal diameter, BD; ③ Height, H; (b) EZ-MH angle: the angle whose vertex was located at the center of the hole, and the endpoints of both sides were located at the anterior border of the EZ band edge, (c) EZ-NFL angle, (d) EZ-GCL angle, (e) EZ-INL angle, (f) EZ-OPL angle, (g) EZ-ONL angle. The EZ-NFL, EZ-GCL, EZ-INL, EZ-OPL, and EZ-ONL angles were each between a line connecting the two upper edges of the EZ band and a line through the upper edge of the respective band. h Basal angle formed by the base of the macular hole and the RPE layer, (i) Basal-NFL angle between a line connecting the base of the macular hole and the edge of the NFL and the line of the RPE
Fig. 3
Fig. 3
Comparison of angles from different directions and AR of each angle between the two groups. EZ, ellipsoid zone; NFL, nerve fiber layer; GCL, ganglion cell layer; INL, inner nuclear layer; ONL, outer nuclear layer; OPL, outer plexiform layer; AR, angle regularity. P < 0.05 is marked with *, P < 0.01 is marked with ** and P < 0.001 is marked with ***
See this image and copyright information in PMC

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