The effect of retinal structure on surgical success in macular holes

Purpose: It is aimed to evaluate the effects of preoperative hole structure, size, techniques used during surgery, postoperative anatomical and functional success in patients with macular holes, and to determine the change in retinal layers by optical coherence tomography (OCT). Materials and Methods: The study was conducted by including 48 eyes of 45 patients who underwent surgery with the diagnosis of macular hole between January 1, 2013 and August 1, 2019 and were followed up for at least 6 months in the postoperative period. Preoperative and postoperative 1st, 3rd, and 6th month detailed ophthalmological examinations were performed and Best Corrected Visual Acuity (BCVA) was obtained. Okt images of hole structure and retinal layers were evaluated. Results: 45 patients, 23 (51.1%) female and 22 (48.9%) male, were included in the study. The ages of the patients varied between 28-81 years and the mean age was 68.4 ± 8.7. The average duration of complaints was 6.8 ± 5.3 (2-24) months, and when evaluated according to the etiology, 44 (91.7%) of the cases had idiopathic macular hole, 2 (4.2%) had traumatic macular hole, and 2 (%) had 4,2) there was a macular hole after detachment. While anatomical success was achieved in 38 (79.2%) of the cases after surgery; Functional success was achieved in 36 (75.0%) of them. Functional (p <0.001) and anatomical success (p <0.001) were found to decrease as the duration of symptoms increased. No statistically significant relationship was found between the techniques used during the operation and anatomical and functional success. When the preoperative visual acuity was compared with the postoperative 3rd month (p <0.001) and 6th month (p <0.001), a statistically significant difference was observed between visual acuities. After surgery, visual acuity was significantly increased up to 6 months (p <0.001) When looking at the relationship between hole edge parameters and pre-operative visual acuity Negative correlation between minimum hole diameter and visual acuity at postoperative 1st month (r = 0.423; p = 0.003), 3rd month (r = 0.423; p = 0.003) and 6th month (r = 0.389; p = 0.006) was detected. Negative correlation between basal hole diameter and visual acuity at postoperative 1st month (r = 0.499; p <0.001), 3rd month (r = 0.506; p <0.001) and 6th month (r = 0.521; p <0.001) was detected. With macular hole index (MHI), postoperative 1st month (r =-0.546; p <0.001), 3rd month (r =-0.517; p <0.001) and 6th month (r =-0.527; p <0.001) there was a positive correlation between visual acuity. With tractional hole index(THI), postoperative 1st month (r = -0.546; p <0.001), 3rd month (r = -0.517; p <0.001) and 6th month (r = -0.527; p <0.001) ) there was a positive correlation between visual acuity. When the effect of the integrity of the outer limiting membrane (DLM) and Elipsoid zone (EZ) on postoperative visual acuity in the 3rd and 6th month was evaluated; Visual acuity was higher in patients with integrated DLM and / or EZ at postoperative 3 and 6 months (p <0.001). Conclusion: Surgical closureof macular holes provides anatomical and functional recovery. It was determined that the minimum hole diameter and basal hole diameter, and MHI and THI, among the edge parameters measured by preoperative OCT, have significant effects on functional success.