TY - JOUR
T1 - Predictive model for macular hole closure speed
T2 - Insights from intraoperative optical coherence tomography
AU - Ehlers, Justis P.
AU - Uchida, Atsuro
AU - Srivastava, Sunil K.
AU - Hu, Ming
N1 - Funding Information:
Supported by National Institutes of Health/National Eye Institute K23-EY022947-01A1 (JPE); Ohio Department of Development TECH-13-059 (JPE); Research to Prevent Blindness (Cole Eye Institutional Grant); Unrestricted travel grant from Alcon Novar-tis Hida Memorial Award 2015 funded by Alcon Japan Ltd. (AU).
Funding Information:
The following outlines the contributions of the authors: design of the study (JPE); conduct of the study (all authors); data collection (JPE, SKS); data management (JPE, MH, AU); data analysis (all authors); data interpretation (all authors); preparation of the manuscript (JPE, MH, AU); review and approval of the manuscript (all authors). Supported by National Institutes of Health/National Eye Institute K23-EY022947-01A1 (JPE); Ohio Department of Development TECH-13-059 (JPE); Research to Prevent Blindness (Cole Eye Institutional Grant); Unrestricted travel grant from Alcon Novartis Hida Memorial Award 2015 funded by Alcon Japan Ltd. (AU).
Publisher Copyright:
© 2019 The Authors.
PY - 2019/1
Y1 - 2019/1
N2 - Purpose: To establish a predictive model of macular hole (MH) closure speed. Methods: This study was a post hoc analysis of eyes that underwent full-thickness MH repair in the prospective PIONEER intraoperative optical coherence tomography (iOCT) study. The Bioptigen SDOIS system was used for iOCT imaging. All patients underwent standard small-gauge vitrectomy with internal limiting membrane (ILM) peeling, gas tamponade, and postoperative facedown positioning. Before vitrectomy and after ILM peeling, various quantitative OCT measures related to MH were obtained, including MH geometry alterations and outer retinal features. Trans-gas OCT was performed on postoperative day 1 to evaluate MH closure. Univariate and multivariate analyses were conducted to identify predictors of early MH closure (i.e., postoperative day 1 [POD 1] closure). Results: Thirty-two (86%) out of 37 eyes were confirmed for MH closure at POD 1. At 3 months, MH closure was achieved in 35 (95%) eyes. After multivariate logistic regression analyses, seven covariates were determined as predictors for MH closure. These seven covariates included age, ellipsoid zone-retinal pigment epithelium expansion following ILM peel, preincision minimal width, post-ILM peel MH depth, change in MH volume, change in minimum MH width, and change in MH depth. Using these seven covariates, the area under the curve was 0.974. Cross-validation analysis indicated that intraoperative change in MH volume, intraoperative change in minimal width, and preincision minimal width were the most robust predictors for early MH. Conclusions: This study suggests that iOCT may be important in predicting MH closure speed and may be a surrogate for tissue properties/behavior. A future prospective clinical trial is needed to validate this model. Translational Relevance: This study provides unique insights into the potential role of iOCT imaging in predicting retinal tissue behavior during MH repair.
AB - Purpose: To establish a predictive model of macular hole (MH) closure speed. Methods: This study was a post hoc analysis of eyes that underwent full-thickness MH repair in the prospective PIONEER intraoperative optical coherence tomography (iOCT) study. The Bioptigen SDOIS system was used for iOCT imaging. All patients underwent standard small-gauge vitrectomy with internal limiting membrane (ILM) peeling, gas tamponade, and postoperative facedown positioning. Before vitrectomy and after ILM peeling, various quantitative OCT measures related to MH were obtained, including MH geometry alterations and outer retinal features. Trans-gas OCT was performed on postoperative day 1 to evaluate MH closure. Univariate and multivariate analyses were conducted to identify predictors of early MH closure (i.e., postoperative day 1 [POD 1] closure). Results: Thirty-two (86%) out of 37 eyes were confirmed for MH closure at POD 1. At 3 months, MH closure was achieved in 35 (95%) eyes. After multivariate logistic regression analyses, seven covariates were determined as predictors for MH closure. These seven covariates included age, ellipsoid zone-retinal pigment epithelium expansion following ILM peel, preincision minimal width, post-ILM peel MH depth, change in MH volume, change in minimum MH width, and change in MH depth. Using these seven covariates, the area under the curve was 0.974. Cross-validation analysis indicated that intraoperative change in MH volume, intraoperative change in minimal width, and preincision minimal width were the most robust predictors for early MH. Conclusions: This study suggests that iOCT may be important in predicting MH closure speed and may be a surrogate for tissue properties/behavior. A future prospective clinical trial is needed to validate this model. Translational Relevance: This study provides unique insights into the potential role of iOCT imaging in predicting retinal tissue behavior during MH repair.
KW - Intraoperative optical coherence tomography
KW - Macular hole
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U2 - 10.1167/tvst.8.1.18
DO - 10.1167/tvst.8.1.18
M3 - Article
AN - SCOPUS:85068484757
SN - 2164-2591
VL - 8
JO - Translational Vision Science and Technology
JF - Translational Vision Science and Technology
IS - 1
M1 - 18
ER -