The Importance of Anatomic Configuration and Cystic Changes in Macular Hole: Predicting Surgical Success with a Different Approach

Abstract PurposeThis study aimed to define novel metrics for the area of the macular hole (MH) and the cysts placed around the hole using an optical coherence tomography (OCT) device.MethodsThis retrospective, cross-sectional study was conducted with 58 eyes of 56 patients. The patients were divided into two groups according to anatomic closure after surgery. The novel metrics including macular hole index (MHI), tractional hole index (THI), and (hole forming factor) HFF, macular hole area (HA), the cystoid space areas in the inner retinal layers (CA), and the cyst hole area index (CHAI) were calculated. Correlation of the CA, the HA, and the CHAI with other indexes was assessed. Receiver operating characteristic (ROC) curves and cut-off values were derived for indexes predicting type 1 or type 2 closures.ResultsThe CA positively correlated with the base MH size and the maximum MH height (p <0.001, p <0.001, respectively). The HA showed a positive correlation with basal MH size, minimum MH size, and maximum MH height (p <0.001, p <0.001, p <0.001, respectively). CHAI was positively correlated with minimum MH size. (p = 0.02). CHAI and HA were negatively correlated with postoperative BCVA (p= 0.003, p=0.006, respectively). ROC curve analysis showed that MHI, THI, and HFF predicted type 1 closure; on the other hand, CHAI and HA predicted type 2 closures.ConclusionsMHI and our novel index CHAI, which can be calculated without any additional software, could successfully predict type 1 and type 2 closures, respectively.