The Effect of Retinal Structure on Surgical Success in Macular Holes

The Effect of Retinal Structure on Surgical Success in Macular Holes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Retinal Structure on Surgical Success in Macular Holes AHMET MEHMET SOMUNCU, MEHMET KOLA, HİDAYET ERDÖL, BÜSRA KÖSE, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4722666/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To evaluate the effects of preoperative hole structure and size on postoperative anatomical and functional success in patients with macular holes and determine the changes in retinal layers using optical coherence tomography (OCT). Methods: This study included 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 six months in the postoperative period. Results: Forty-five patients, 23 (51.1%) female and 22 (48.9%) male, were included in the study. There was a statistically significant difference between the preoperative visual acuity and the postoperative third-month and sixth-month visual acuity values. After surgery, visual acuity significantly increased for up to six months. When examining the relationship between hole edge parameters and preoperative visual acuity, a negative correlation was detected between the minimum hole diameter, basal hole diameter and the visual acuities measured at the postoperative. The macular hole index (MHI) and The tractional hole index (THI) had a positive correlation with the postoperative visual acuities. The assessment of the effect of the integrity of the outer limiting membrane (OLM) and the ellipsoid zone (EZ) on postoperative visual acuity at the third and sixth months revealed that visual acuity was higher in patients with OLM and/or EZ integrity at these evaluation times. Conclusion: The surgical closure of macular holes provides anatomical and functional recovery. This study showed that the minimum hole diameter and basal hole diameter, as well as MHI and THI, among the edge parameters measured by preoperative OCT, had a significant effect on functional success. Macular hole optical coherence tomography vitrectomy retinal layers visual acuity Figures Figure 1 Figure 2 Figure 3 INTRODUCTION A macular hole is an interface pathology characterized by full-thickness neural retina loss in the center of the macula, causing significant complaints, such as decreased central vision, central scotoma, and metamorphopsia. It is mostly idiopathic and has an incidence of 1.1/3,000, being more common in women (female/male: 3/1). It is most common between the ages of 60 and 70 years. Although most cases are unilateral, bilateral presentation can be observed in 10–20% of cases. In 1988, Gass and Johnson were the first to suggest that idiopathic macular holes have been caused by the tangential tractions on the fovea and described four stages of macular holes. Currently, the utilization of optical coherence tomography (OCT) facilitates the diagnosis of this condition and allows for a detailed structural evaluation. With the exception of some cases resulting from trauma, the only treatment method is surgical intervention. Following the 1991 publication by Kelly and Wendel on the efficacy of pars plana vitrectomy, posterior hyaloid peeling, and intraocular gas tamponade in closing macular holes and achieving functional recovery, the surgical treatment for idiopathic macular holes has become widely adopted. In order to enhance surgical success, in recent years, surgeons have increasingly performed pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of macular holes. As part of this treatment, the patient will be asked to lie on their stomach for a certain period of time [ 1 – 6 ]. The objectives of this study were of the preoperative hole structure and dimensions on the postoperative anatomical and functional success in patients with macular holes and determine the changes in retinal layers using OCT. Methods Ethical approval was obtained from the Ethics Committee of the K.T.U. Faculty of Medicine on November 22, 2019, with the number 24237859-340. The possible risks of surgery and the benefits of treatment were explained to all patients, and their informed consent was obtained before surgery in accordance with the principles of the Declaration of Helsinki. Setting and participants This study was carried out by including 48 eyes of 45 patients who had undergone the surgical procedure with the diagnosis of macular hole between January 1, 2013, and August 1, 2019, and were followed up for at least six months in the postoperative period. Preoperative and postoperative first-, third-, and sixth-month detailed ophthalmological examinations were performed, and best-corrected visual acuity values were obtained. The OCT images of the hole structure and retinal layers were evaluated. Preoperatively, gender, affected eye, age, visual acuity, etiology, duration of complaints, lens transparency, and staging of the holes were recorded. The staging of the holes was determined using the Gass classification according to the results of the fundus examination and OCT. The OCT parameters evaluated in the preoperative period included the basal hole diameter at the retinal pigment epithelium level, the minimum hole diameter (the shortest distance between the hole lips), the hole height extending from the retinal pigment epithelium level to the ILM, the tractional hole index (THI) and the macular hole index (MHI) (the ratios of the hole height to the minimum hole diameter and basal hole diameter, respectively), the diameter hole index (DHI) (the ratio of the minimum hole diameter to the basal diameter), the hole form factor (HFF) (the ratio of the total length of the hole arms to the basal hole diameter to length), the presence of operculum, cystoid changes on the hole edge, and the presence of epiretinal membrane (Fig. 1 ). Postoperatively, anatomical and functional success was evaluated. Anatomical success was defined as occlusion of the sensory retinal defect and disappearance of subretinal fluid around the hole, while functional success was an increase in visual acuity of two or more lines on the Snellen chart. Patients were divided into two groups on the basis of the integrity of the outer limiting membrane (OLM) and the ellipsoid zone (EZ). The absence of any neurosensory tissue defect was considered a type 1 closure, while the presence of a neurosensory tissue defect was considered a type 2 closure (Figs. 2 , 3 ). Best-corrected visual acuity values were measured preoperatively and at the postoperative first, third, and sixth months and converted to logMAR (logarithm of the minimum angle of resolution) for statistical comparisons. During OCT, five horizontal and five vertical scans were performed using grid scanning. The section that provided the most accurate measurement of the hole was selected. The hole size and the number of defects in the retinal layers were imaged using OCT and measured manually by utilizing the software of the device. Surgical Technique The reverse ILM flap technique was used in all patients. Following core vitrectomy and ILM staining, the ILM was peeled back to the edge of the macular hole. This ILM flap was then inverted to cover and fill the macular hole. Lastly, a fluid-air exchange was carried out. Statistical analysis The data of the study were analysed using IBM SPSS Statistics version 23.0 software. Mean, standard deviation, minimum and maximum values were used to present descriptive statistics for measurement data and numbers and percentages for qualitative data. The conformity of the measured data to normal distribution was evaluated by Shapiro-Wilk test.. In the analysis of the data between two independent groups, the Student's t-test was used when parametric properties were met, otherwise the Mann-Whitney U test was used. Since normal distribution conditions were not met for the comparisons of dependent groups, the Wilcoxon test was used. The measurement data of more than two independent groups were compared with the Kruskal-Wallis test. When a significant difference was detected between groups, the source of the difference was determined using the Bonferroni test. Qualitative data were analyzed using the chi-square test. Relationships between measurement data were determined using the Spearman correlation analysis. The statistical significance level was accepted as P < 0.05. RESULTS Forty-five cases, 23 (51.1%) female and 22 (48.9%) male, were included in the study. Patients ranged in age from 28 to 81 years, with a mean age of 68.4 ± 8.7 years. The average duration of complaints was 6.8 ± 5.3 (2–24) months. When evaluated according to the etiology of macular holes, 44 (91.7%) of the cases were idiopathic, two (4.2%) were traumatic, and two (4.2%) developed secondary to detachment (Table 1 ). Table 1 Patient descriptive characteristics n % Gender (n = 45) Female 23 51.1 Male 22 48.9 Affected eye Right 30 62.5 Left 18 37.5 Etiology Idiopathic 44 91.6 Trauma 2 4.2 Post-detachment 2 4.2 Presence of comorbidity Present 39 81.2 Absent 9 18.8 Comorbidity* Hypertension 27 56.4 Goiter 11 22.9 Diabetes mellitus 8 16.7 Benign prostate hypertrophy 6 12.5 Coronary artery disease 5 10.4 Laryngeal cancer 1 2.1 Mean ± SD Min-Max Age (year) 68.4 ± 8.7 28–81 Duration of complaints (month) 6.8 ± 5.3 2–24 SD: standard deviation Postoperatively, anatomical success was achieved in 38 (79.2%) of the cases, and functional success in 36 (75.0%). Functional (p < 0.001) and anatomical (p < 0.001) success rates were found to decrease as the duration of symptoms increased (Table 2 ). Table 2 Relationship between the duration of complaints and logMAR visual acuity values r p Preoperative visual acuity 0.523 < 0.001 Postoperative first-month visual acuity 0.526 < 0.001 Postoperative third-month visual acuity 0.697 < 0.001 Postoperative sixth-month visual acuity 0.808 < 0.001 The evaluation of the effect of the hole stage on the closure of the hole revealed that the closure rate was lower in patients with a more advanced hole stage. Anatomical success was achieved in all of the patients with stage 2 macular holes, 18 (81.8%) of the 22 patients with stage 3 macular holes, and 17 (73.9%) of the 23 patients with stage 4 macular holes (Table 3 ). Table 3 Hole closure rates according to the hole stage Hole Closure Condition Closed Open n % n % Hole stage Stage 2 3 100.0 0 0.0 Stage 3 18 81.8 4 18.2 Stage 4 17 73.9 6 26.1 Total 38 79.2 10 20.8 As the hole stage increased, the visual acuity values decreased preoperatively and at the postoperative first, third, and sixth months. Table 4 presents the visual acuity values according to the hole stage. Table 4 LogMAR visual acuity values according to the hole stage Mean ± SD r p Preoperative visual acuity Stage 2 0.567 ± 0.115 0.445 0.002 Stage 3 0.886 ± 0.247 Stage 4 1.122 ± 0.341 Postoperative first-month visual acuity Stage 2 0.733 ± 0.251 0.330 0.022 Stage 3 0.873 ± 0.276 Stage 4 1.091 ± 0.348 Postoperative third-month visual acuity Stage 2 0.667 ± 0.351 0.300 0.038 Stage 3 0.723 ± 0.289 Stage4 0.957 ± 0.405 Postoperative sixth-month visual acuity Stage 2 0.500 ± 0.200 0.313 0.030 Stage 3 0.632 ± 0.357 Stage 4 0.835 ± 0.383 SD: standard deviation Statistically significant differences were observed between the preoperative visual acuity and the postoperative third-month (p < 0.001) and sixth-month (p < 0.001) visual acuity values. After surgery, visual acuity significantly increased for up to six months (p < 0.001) When examining the relationship between the hole edge parameters and the preoperative visual acuity, a negative correlation was detected between the minimum hole diameter and the visual acuity values measured at the postoperative first (r = 0.423; p = 0.003), third (r = 0.423; p = 0.003), and sixth (r = 0.389; p = 0.006) months. There was also a negative correlation between the basal hole diameter and the visual acuity values measured at the postoperative first (r = 0.499; p < 0.001), third (r = 0.506; p < 0.001), and sixth (r = 0.521; p < 0.001) months. MHI had a positive correlation with the visual acuity values measured at the postoperative first (r =-0.546; p < 0.001), third (r =-0.517; p < 0.001), and sixth (r = -0.527; p < 0.001) month. THI was also positively correlated with the postoperative first-month (r = -0.546; p < 0.001), third-month (r = -0.517; p < 0.001), and sixth-month (r = -0.527; p < 0.001) visual acuity values (Table 5 ). Table 5 Effect of the hole edge parameters measured by preoperative optical coherence tomography on logMAR visual acuity Preoperative OCT findings Preoperative Postoperative first month Postoperative third month Postoperative sixth month r p r p r p r p Minimum hole diameter 0.538 < 0.001 0.459 0.001 0.423 0.003 0.389 0.006 Basal hole diameter 0.669 < 0.001 0.499 < 0.001 0.506 < 0.001 0.521 < 0.001 Hole height 0.275 0.058 0.090 0.545 0.122 0.408 0.194 0.186 Macular hole index -0.659 < 0.001 -0.546 < 0.001 -0.517 < 0.001 -0.527 < 0.001 Tractional hole index -0.442 0.002 -0.437 0.002 -0.389 0.006 -0.337 0.019 Diameter hole index -0.053 0.721 0.430 0.774 0.027 0.853 -0.032 0.828 Hole form factor -0.120 0.418 -0.081 0.586 -0.127 0.391 -0.075 0.614 OCT: optical coherence tomography Upon evaluating the effect of the integrity of OLM and EZ on postoperative visual acuity at the third and sixth months, it was determined that the visual acuity values were higher in patients with OLM and/or EZ integrity at these evaluation times (p < 0.001) (Table 6 ). Table 6 Postoperative visual acuity according to the integrity of OLM and EZ Visual acuity evaluation time Mean ± SD p Postoperative third month OLM integrity Present 0.624 ± 0.240 < 0.001 Absent 1.147 ± 0.295 EZ integrity Present 0.533 ± 0.178 < 0.001 Absent 1.010 ± 0.333 Postoperative sixth month OLM integrity Present 0.472 ± 0.179 < 0.001 Absent 1.100 ± 0.258 EZ integrity Present 0.463 ± 0.180 < 0.001 Absent 1.052 ± 0.289 OLM: outer limiting membrane, EZ: ellipsoid zone, SD: standard deviation Of the 38 cases in which the hole was closed, 26 (68.4%) had a type 1 closure, and 12 (31.6%) had a type 2 closure. The criterion for type 1 closure was the confirmation of the integrity of OLM and EZ at the postoperative sixth month. The visual acuity values at the postoperative sixth month were found to be higher in cases with type 1 closure than in those with type 2 closure (p < 0.001 ) . The examination of the hole edge parameters according to the hole closure type showed that HFF was statistically significantly higher in cases with type 1 closure than in those with type 2 closure (p = 0.022) (Table 7 ). Table 7 Hole edge parameters according to the closure type Parameter Type 1 closure Type 2 closure p (Mean ± SD) (Mean ± SD) Minimum hole diameter 390.3 ± 182.7 493.7 ± 291.3 0.194 Basal hole diameter 888.9 ± 333.9 1131.1 ± 460.1 0.078 Hole height 499.7 ± 80.0 434.7 ± 107.5 0.923 Macular hole index 0.624 ± 0.508 0.445 ± 0.200 0.055 Tractional hole index 1.621 ± 1.640 1.185 ± 0.884 0.267 Diameter hole index 0.460 ± 0.191 0.457 ± 0.200 0.963 Hole form factor 0.788 ± 0.162 0.641 ± 0.190 0.022 SD: standard deviation DISCUSSION Studies on macular hole shape and size have intensified, aiming to identify candidates who would benefit from macular hole surgery. Traditionally, an attempt has been made to calculate the size of the macular hole based on biomicroscopic examination or photographic assessment. The applicability of advances in imaging technology to fundus examination has accelerated studies to determine the macular hole diameter. Consequently, the effects of hole diameters and indices on anatomical and functional success have become the subject of extensive research [ 7 , 8 ]. In 2009, Gupta et al. reported 93% anatomical and 42% functional success rates in cases with a minimum hole diameter of less than 400 microns. Conversely, for cases with a minimum hole diameter larger than 400 microns, the anatomical and functional success rates decreased to 42% and 20%, respectively [ 9 ]. In a study conducted by Zou and Zeng in 2019, it was determined that patients with postoperative low visual acuity had high minimum and basal hole diameters [ 10 ]. Previous studies have demonstrated that postoperative visual acuity is inferior in patients exhibiting a high basal diameter in preoperative OCT measurements [ 11 , 12 , 13 – 15 ]. Consistent with the literature, our study showed that the basal hole diameter was smaller in cases with functional success. Hole height expressed in terms of the maximum distance between the retinal pigment epithelium and the vitreoretinal interface, is another preoperative OCT parameter considered to have an impact on postoperative success, but studies have indicated no correlation between hole height and postoperative visual acuity [ 11 , 16 , 17 , 13 , 14 , 18 , 19 ]. Consistent with the literature, our study found, no significant difference was detected between the hole heights of the cases with and without functional success. There was a positive correlation between HFF and postoperative visual acuity, however, the strength of this correlation was rather weak compared to the minimum and initial hole diameters (12,18). In 2014, Gosai et al. showed that visual acuity was better after surgery in cases with HFF value > 0.9 [ 19 ]. In our study, unlike the literature, we did not find a correlation between HFF and visual acuity increase. MHI is expressed as the hole height divided by the baseline hole diameter and has been shown to correlate positively with postoperative visual acuity in many studies [ 11 , 17 , 14 , 19 ]. It has been reported that eyes with an MHI value of ≥ 0.5 have better visual acuity than those with an MHI value of < 0.5, indicating that this index can be very helpful in clinical practice. It has been suggested that MHI can be used as a predictive factor for visual outcomes after macular hole operation [ 21 ]. Consistent with the literature, in our study, MHI was found to be higher in cases with functional success. In 2008, Ruiz-Moreno et al. performed a retrospective review of 46 cases and reported that the THI surface correlated with visual acuity at three months after surgery, and that a THI surface score above 1.41 was a predictive factor for a good visual prognosis [ 11 ]. However, in later studies where THI was examined as a predictor, the predictive ability of this index was found to be weaker [ 17 , 19 ]. In our study, it was determined that the predictive effect of THI diminished over time during the follow-up period; however, it remained positively correlated with visual acuity at the postoperative first, third, and sixth months. In 2012, Wakely et al. reported that DHI was not correlated with visual acuity and could not be used as a predictive factor [ 17 ]. In our study, no correlation was found between visual acuity and DHI during postoperative follow-up. The duration of complaints and the hole stage are suggested to be the most important parameters affecting postoperative anatomical and functional success. In 1994, Ryan and Gilbert researched the effect of the duration of complaints on surgical success in macular hole surgery and divided the patients into two groups according to this duration. The writers declared that the rate of macular hole closure was 75% in patients with a complaint duration of less than six months and 60% in those with a complaint duration of more than six months [ 22 ]. A regression analysis performed in 2000 by the Vitrectomy for Macular Hole Study Group included 91 patients and revealed that the preoperative macular hole stage was associated with postoperative visual acuity. In that study, 65.9% of the patients in the stage 2 macular hole group had a postoperative visual acuity of 6/12 or better, while this rate remained at 15.0% for patients with stage 3 or 4 macular holes [ 23 ]. In 2003, Kang et al. categorized the postoperative closure of macular holes into two groups: type 1 and type 2. The authors stated that visual acuity was better in those with type 1 closure than in those with type 2 closure [ 24 ]. Unlike the literature, our study demonstrated that among the hole edge parameters examined according to the closure type, a high HFF could be used as a prognostic factor for type 1 closure. Furthermore, among the edge parameters measured by preoperative OCT, the minimum hole diameter, the basal hole diameter, MHI, and THI were found to be higher in type 1 closure cases, although the differences were not statistically significant. Achieving type 1 closure is the most desired postoperative outcome in macular hole surgery. Therefore, we believe that the ability to predict type 1 closure preoperatively is valuable for providing patients with informed expectations. In conclusion, the surgical closure of macular holes provides anatomical and functional recovery. The results of this study exhibit that the minimum hole diameter and basal hole diameter, as well as MHI and THI, among the hole edge parameters measured by preoperative OCT, had a significant effect on functional success. Declarations Author Contribution All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Ahmet Mehmet Somuncu, Mehmet Kola, Hidayet Erdöl, Büşra Köse]. The first draft of the manuscript was written by [Ahmet Mehmet Somuncu, Cenap esenülkü] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement We would like to thank büşra parlak somuncu for her contribution to the study References Aaberg TM, Blair CJ, Gass JDM (1970) Macular holes. Am J Ophthalmol 69(4):555–62. Ezra E (2001) Idiopathic full thickness macular hole: Natural history and pathogenesis. 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SOMUNCU","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYFACHmROhY2cAZhhYEFASwKMcybN2ICBGaRFgkgtjG2HEzeAtTDg1qLb3nt0w8cfdXK6M3IPfuY5czh9O3v/0Q0/CiQY+Nu7E7BpMTtzLu3mjITDxmY38pKleSrSc3f2HGa72QN0mMSZsxuwarmRY3abJ+FA4jYgg5nnjHXuhhvJbDd4gFoMJHKxa7n/xuz2n4Q6iBbeNuZ0A6CWm3/wabnBY3abIYEZpsU5AaTlNl5bzuSY3exJA/rlzBtjyTln0gw3nDlsdlvGQIIHp1+OnzG78cOmTs7seI7hhzcVNvIGxxuf3Xzzx0aOv70XqxbcgIewklEwCkbBKBgFuAAAviZoF8HuIHwAAAAASUVORK5CYII=","orcid":"","institution":"Department of Ophthalmology, Medical Faculty, Erzincan Binali Yildirim University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"AHMET","middleName":"MEHMET","lastName":"SOMUNCU","suffix":""},{"id":329658241,"identity":"97a2452f-b806-4f13-a1fb-3d0f94d5f108","order_by":1,"name":"MEHMET KOLA","email":"","orcid":"","institution":"Department of Ophthalmology, Medical Faculty, Karadeniz Technical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"MEHMET","middleName":"","lastName":"KOLA","suffix":""},{"id":329658242,"identity":"aa18f575-cae0-4228-b6ab-704833d2d96e","order_by":2,"name":"HİDAYET ERDÖL","email":"","orcid":"","institution":"Department of Ophthalmology, Medical Faculty, Karadeniz Technical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"HİDAYET","middleName":"","lastName":"ERDÖL","suffix":""},{"id":329658243,"identity":"d5585b87-f050-40e1-b1be-97f2b20b70cf","order_by":3,"name":"BÜSRA KÖSE","email":"","orcid":"","institution":"Department of Ophthalmology, Medical Faculty, Karadeniz Technical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"BÜSRA","middleName":"","lastName":"KÖSE","suffix":""},{"id":329658244,"identity":"ce481944-9128-4e0c-ae4d-4bf735d12653","order_by":4,"name":"CENAP ESENÜLKÜ","email":"","orcid":"","institution":"Health Scıences Unıversıty Kanunı Educatıon And Research Hospıtal","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"CENAP","middleName":"","lastName":"ESENÜLKÜ","suffix":""}],"badges":[],"createdAt":"2024-07-11 08:01:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4722666/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4722666/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62220636,"identity":"6e3e47b7-ef68-4453-adf7-7e19ad2b6c9d","added_by":"auto","created_at":"2024-08-11 12:23:32","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":60005,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSchematized representation of hole edge measurements\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4722666/v1/71b86ee1e176ce6e3c596117.jpeg"},{"id":62219578,"identity":"74a45cf9-376f-452a-9c7c-2ededb2ebe9b","added_by":"auto","created_at":"2024-08-11 12:15:32","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":34897,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eType 1 closure example\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4722666/v1/23f175b1fbb7ae452c570369.jpeg"},{"id":62219583,"identity":"50c60748-c756-4c59-bf29-e2b1a4f082d1","added_by":"auto","created_at":"2024-08-11 12:15:32","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":47814,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eType 2 closure example\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4722666/v1/0b7ec1f63b7fd5848f847ae5.jpeg"},{"id":62685698,"identity":"5f1f254c-9c1f-4a9f-a31e-38137de8c745","added_by":"auto","created_at":"2024-08-17 13:59:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":937154,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4722666/v1/20b198c4-f866-4625-84ae-c12d1158b11b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Effect of Retinal Structure on Surgical Success in Macular Holes\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eA macular hole is an interface pathology characterized by full-thickness neural retina loss in the center of the macula, causing significant complaints, such as decreased central vision, central scotoma, and metamorphopsia. It is mostly idiopathic and has an incidence of 1.1/3,000, being more common in women (female/male: 3/1). It is most common between the ages of 60 and 70 years. Although most cases are unilateral, bilateral presentation can be observed in 10\u0026ndash;20% of cases.\u003c/p\u003e \u003cp\u003eIn 1988, Gass and Johnson were the first to suggest that idiopathic macular holes have been caused by the tangential tractions on the fovea and described four stages of macular holes. Currently, the utilization of optical coherence tomography (OCT) facilitates the diagnosis of this condition and allows for a detailed structural evaluation. With the exception of some cases resulting from trauma, the only treatment method is surgical intervention.\u003c/p\u003e \u003cp\u003eFollowing the 1991 publication by Kelly and Wendel on the efficacy of pars plana vitrectomy, posterior hyaloid peeling, and intraocular gas tamponade in closing macular holes and achieving functional recovery, the surgical treatment for idiopathic macular holes has become widely adopted. In order to enhance surgical success, in recent years, surgeons have increasingly performed pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade in the treatment of macular holes. As part of this treatment, the patient will be asked to lie on their stomach for a certain period of time [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe objectives of this study were of the preoperative hole structure and dimensions on the postoperative anatomical and functional success in patients with macular holes and determine the changes in retinal layers using OCT.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003ewas obtained from the Ethics Committee of the K.T.U. Faculty of Medicine on November 22, 2019, with the number 24237859-340. The possible risks of surgery and the benefits of treatment were explained to all patients, and their informed consent was obtained before surgery in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting and participants\u003c/h2\u003e \u003cp\u003e This study was carried out by including 48 eyes of 45 patients who had undergone the surgical procedure with the diagnosis of macular hole between January 1, 2013, and August 1, 2019, and were followed up for at least six months in the postoperative period. Preoperative and postoperative first-, third-, and sixth-month detailed ophthalmological examinations were performed, and best-corrected visual acuity values were obtained. The OCT images of the hole structure and retinal layers were evaluated.\u003c/p\u003e \u003cp\u003ePreoperatively, gender, affected eye, age, visual acuity, etiology, duration of complaints, lens transparency, and staging of the holes were recorded. The staging of the holes was determined using the Gass classification according to the results of the fundus examination and OCT.\u003c/p\u003e \u003cp\u003eThe OCT parameters evaluated in the preoperative period included the basal hole diameter at the retinal pigment epithelium level, the minimum hole diameter (the shortest distance between the hole lips), the hole height extending from the retinal pigment epithelium level to the ILM, the tractional hole index (THI) and the macular hole index (MHI) (the ratios of the hole height to the minimum hole diameter and basal hole diameter, respectively), the diameter hole index (DHI) (the ratio of the minimum hole diameter to the basal diameter), the hole form factor (HFF) (the ratio of the total length of the hole arms to the basal hole diameter to length), the presence of operculum, cystoid changes on the hole edge, and the presence of epiretinal membrane (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePostoperatively, anatomical and functional success was evaluated. Anatomical success was defined as occlusion of the sensory retinal defect and disappearance of subretinal fluid around the hole, while functional success was an increase in visual acuity of two or more lines on the Snellen chart.\u003c/p\u003e \u003cp\u003ePatients were divided into two groups on the basis of the integrity of the outer limiting membrane (OLM) and the ellipsoid zone (EZ). The absence of any neurosensory tissue defect was considered a type 1 closure, while the presence of a neurosensory tissue defect was considered a type 2 closure (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBest-corrected visual acuity values were measured preoperatively and at the postoperative first, third, and sixth months and converted to logMAR (logarithm of the minimum angle of resolution) for statistical comparisons. During OCT, five horizontal and five vertical scans were performed using grid scanning. The section that provided the most accurate measurement of the hole was selected. The hole size and the number of defects in the retinal layers were imaged using OCT and measured manually by utilizing the software of the device.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSurgical Technique\u003c/h2\u003e \u003cp\u003eThe reverse ILM flap technique was used in all patients. Following core vitrectomy and ILM staining, the ILM was peeled back to the edge of the macular hole. This ILM flap was then inverted to cover and fill the macular hole. Lastly, a fluid-air exchange was carried out.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data of the study were analysed using IBM SPSS Statistics version 23.0 software. Mean, standard deviation, minimum and maximum values were used to present descriptive statistics for measurement data and numbers and percentages for qualitative data.\u003c/p\u003e \u003cp\u003eThe conformity of the measured data to normal distribution was evaluated by Shapiro-Wilk test.. In the analysis of the data between two independent groups, the Student's t-test was used when parametric properties were met, otherwise the Mann-Whitney U test was used. Since normal distribution conditions were not met for the comparisons of dependent groups, the Wilcoxon test was used. The measurement data of more than two independent groups were compared with the Kruskal-Wallis test. When a significant difference was detected between groups, the source of the difference was determined using the Bonferroni test. Qualitative data were analyzed using the chi-square test. Relationships between measurement data were determined using the Spearman correlation analysis. The statistical significance level was accepted as P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eForty-five cases, 23 (51.1%) female and 22 (48.9%) male, were included in the study. Patients ranged in age from 28 to 81 years, with a mean age of 68.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7 years. The average duration of complaints was 6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 (2\u0026ndash;24) months. When evaluated according to the etiology of macular holes, 44 (91.7%) of the cases were idiopathic, two (4.2%) were traumatic, and two (4.2%) developed secondary to detachment (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient descriptive characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender (n\u0026thinsp;=\u0026thinsp;45)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAffected eye\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEtiology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIdiopathic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-detachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePresence of comorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eComorbidity*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGoiter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBenign prostate hypertrophy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoronary artery disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaryngeal cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMin-Max\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u0026ndash;81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of complaints (month)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003eSD: standard deviation\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePostoperatively, anatomical success was achieved in 38 (79.2%) of the cases, and functional success in 36 (75.0%). Functional (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and anatomical (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) success rates were found to decrease as the duration of symptoms increased (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between the duration of complaints and logMAR visual acuity values\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreoperative visual acuity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative first-month visual acuity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative third-month visual acuity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePostoperative sixth-month visual acuity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.808\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe evaluation of the effect of the hole stage on the closure of the hole revealed that the closure rate was lower in patients with a more advanced hole stage. Anatomical success was achieved in all of the patients with stage 2 macular holes, 18 (81.8%) of the 22 patients with stage 3 macular holes, and 17 (73.9%) of the 23 patients with stage 4 macular holes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHole closure rates according to the hole stage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eHole Closure Condition\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eClosed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eHole stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs the hole stage increased, the visual acuity values decreased preoperatively and at the postoperative first, third, and sixth months. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the visual acuity values according to the hole stage.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogMAR visual acuity values according to the hole stage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePreoperative visual acuity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.567\u0026thinsp;\u0026plusmn;\u0026thinsp;0.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.886\u0026thinsp;\u0026plusmn;\u0026thinsp;0.247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.122\u0026thinsp;\u0026plusmn;\u0026thinsp;0.341\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePostoperative first-month visual acuity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.733\u0026thinsp;\u0026plusmn;\u0026thinsp;0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.873\u0026thinsp;\u0026plusmn;\u0026thinsp;0.276\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.091\u0026thinsp;\u0026plusmn;\u0026thinsp;0.348\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePostoperative third-month visual acuity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.667\u0026thinsp;\u0026plusmn;\u0026thinsp;0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.723\u0026thinsp;\u0026plusmn;\u0026thinsp;0.289\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.957\u0026thinsp;\u0026plusmn;\u0026thinsp;0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePostoperative sixth-month visual acuity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.500\u0026thinsp;\u0026plusmn;\u0026thinsp;0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.632\u0026thinsp;\u0026plusmn;\u0026thinsp;0.357\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eStage 4\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.835\u0026thinsp;\u0026plusmn;\u0026thinsp;0.383\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003eSD: standard deviation\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStatistically significant differences were observed between the preoperative visual acuity and the postoperative third-month (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and sixth-month (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) visual acuity values. After surgery, visual acuity significantly increased for up to six months (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) When examining the relationship between the hole edge parameters and the preoperative visual acuity, a negative correlation was detected between the minimum hole diameter and the visual acuity values measured at the postoperative first (r\u0026thinsp;=\u0026thinsp;0.423; p\u0026thinsp;=\u0026thinsp;0.003), third (r\u0026thinsp;=\u0026thinsp;0.423; p\u0026thinsp;=\u0026thinsp;0.003), and sixth (r\u0026thinsp;=\u0026thinsp;0.389; p\u0026thinsp;=\u0026thinsp;0.006) months. There was also a negative correlation between the basal hole diameter and the visual acuity values measured at the postoperative first (r\u0026thinsp;=\u0026thinsp;0.499; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), third (r\u0026thinsp;=\u0026thinsp;0.506; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and sixth (r\u0026thinsp;=\u0026thinsp;0.521; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) months. MHI had a positive correlation with the visual acuity values measured at the postoperative first (r =-0.546; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), third (r =-0.517; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and sixth (r = -0.527; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) month. THI was also positively correlated with the postoperative first-month (r = -0.546; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), third-month (r = -0.517; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and sixth-month (r = -0.527; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) visual acuity values (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffect of the hole edge parameters measured by preoperative optical coherence tomography on logMAR visual acuity\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreoperative OCT findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003efirst month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003ethird month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003esixth month\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMinimum hole diameter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBasal hole diameter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHole height\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMacular hole index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTractional hole index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.442\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiameter hole index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHole form factor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eOCT: optical coherence tomography\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUpon evaluating the effect of the integrity of OLM and EZ on postoperative visual acuity at the third and sixth months, it was determined that the visual acuity values were higher in patients with OLM and/or EZ integrity at these evaluation times (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003ePostoperative visual acuity according to the integrity of OLM and EZ\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eVisual acuity evaluation time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ePostoperative third month\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eOLM integrity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.624\u0026thinsp;\u0026plusmn;\u0026thinsp;0.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.147\u0026thinsp;\u0026plusmn;\u0026thinsp;0.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEZ integrity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.533\u0026thinsp;\u0026plusmn;\u0026thinsp;0.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.010\u0026thinsp;\u0026plusmn;\u0026thinsp;0.333\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ePostoperative sixth month\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eOLM integrity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.472\u0026thinsp;\u0026plusmn;\u0026thinsp;0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.100\u0026thinsp;\u0026plusmn;\u0026thinsp;0.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEZ integrity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.463\u0026thinsp;\u0026plusmn;\u0026thinsp;0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.052\u0026thinsp;\u0026plusmn;\u0026thinsp;0.289\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOLM: outer limiting membrane, EZ: ellipsoid zone, SD: standard deviation\u003c/p\u003e \u003cp\u003eOf the 38 cases in which the hole was closed, 26 (68.4%) had a type 1 closure, and 12 (31.6%) had a type 2 closure. The criterion for type 1 closure was the confirmation of the integrity of OLM and EZ at the postoperative sixth month. The visual acuity values at the postoperative sixth month were found to be higher in cases with type 1 closure than in those with type 2 closure (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eThe examination of the hole edge parameters according to the hole closure type showed that HFF was statistically significantly higher in cases with type 1 closure than in those with type 2 closure (p\u0026thinsp;=\u0026thinsp;0.022) (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHole edge parameters according to the closure type\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eType 1 closure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eType 2 closure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMinimum hole diameter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e390.3\u0026thinsp;\u0026plusmn;\u0026thinsp;182.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e493.7\u0026thinsp;\u0026plusmn;\u0026thinsp;291.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBasal hole diameter\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e888.9\u0026thinsp;\u0026plusmn;\u0026thinsp;333.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1131.1\u0026thinsp;\u0026plusmn;\u0026thinsp;460.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHole height\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e499.7\u0026thinsp;\u0026plusmn;\u0026thinsp;80.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e434.7\u0026thinsp;\u0026plusmn;\u0026thinsp;107.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.923\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMacular hole index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.624\u0026thinsp;\u0026plusmn;\u0026thinsp;0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.445\u0026thinsp;\u0026plusmn;\u0026thinsp;0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTractional hole index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.621\u0026thinsp;\u0026plusmn;\u0026thinsp;1.640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.185\u0026thinsp;\u0026plusmn;\u0026thinsp;0.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiameter hole index\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.460\u0026thinsp;\u0026plusmn;\u0026thinsp;0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.457\u0026thinsp;\u0026plusmn;\u0026thinsp;0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHole form factor\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.788\u0026thinsp;\u0026plusmn;\u0026thinsp;0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.641\u0026thinsp;\u0026plusmn;\u0026thinsp;0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.022\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eStudies on macular hole shape and size have intensified, aiming to identify candidates who would benefit from macular hole surgery. Traditionally, an attempt has been made to calculate the size of the macular hole based on biomicroscopic examination or photographic assessment. The applicability of advances in imaging technology to fundus examination has accelerated studies to determine the macular hole diameter. Consequently, the effects of hole diameters and indices on anatomical and functional success have become the subject of extensive research [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2009, Gupta et al. reported 93% anatomical and 42% functional success rates in cases with a minimum hole diameter of less than 400 microns. Conversely, for cases with a minimum hole diameter larger than 400 microns, the anatomical and functional success rates decreased to 42% and 20%, respectively [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a study conducted by Zou and Zeng in 2019, it was determined that patients with postoperative low visual acuity had high minimum and basal hole diameters [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Previous studies have demonstrated that postoperative visual acuity is inferior in patients exhibiting a high basal diameter in preoperative OCT measurements [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Consistent with the literature, our study showed that the basal hole diameter was smaller in cases with functional success.\u003c/p\u003e \u003cp\u003eHole height expressed in terms of the maximum distance between the retinal pigment epithelium and the vitreoretinal interface, is another preoperative OCT parameter considered to have an impact on postoperative success, but studies have indicated no correlation between hole height and postoperative visual acuity [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Consistent with the literature, our study found, no significant difference was detected between the hole heights of the cases with and without functional success.\u003c/p\u003e \u003cp\u003eThere was a positive correlation between HFF and postoperative visual acuity, however, the strength of this correlation was rather weak compared to the minimum and initial hole diameters (12,18). In 2014, Gosai et al. showed that visual acuity was better after surgery in cases with HFF value\u0026thinsp;\u0026gt;\u0026thinsp;0.9 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our study, unlike the literature, we did not find a correlation between HFF and visual acuity increase.\u003c/p\u003e \u003cp\u003eMHI is expressed as the hole height divided by the baseline hole diameter and has been shown to correlate positively with postoperative visual acuity in many studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. It has been reported that eyes with an MHI value of \u0026ge;\u0026thinsp;0.5 have better visual acuity than those with an MHI value of \u0026lt;\u0026thinsp;0.5, indicating that this index can be very helpful in clinical practice. It has been suggested that MHI can be used as a predictive factor for visual outcomes after macular hole operation [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Consistent with the literature, in our study, MHI was found to be higher in cases with functional success.\u003c/p\u003e \u003cp\u003eIn 2008, Ruiz-Moreno et al. performed a retrospective review of 46 cases and reported that the THI surface correlated with visual acuity at three months after surgery, and that a THI surface score above 1.41 was a predictive factor for a good visual prognosis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, in later studies where THI was examined as a predictor, the predictive ability of this index was found to be weaker [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our study, it was determined that the predictive effect of THI diminished over time during the follow-up period; however, it remained positively correlated with visual acuity at the postoperative first, third, and sixth months.\u003c/p\u003e \u003cp\u003eIn 2012, Wakely et al. reported that DHI was not correlated with visual acuity and could not be used as a predictive factor [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In our study, no correlation was found between visual acuity and DHI during postoperative follow-up.\u003c/p\u003e \u003cp\u003eThe duration of complaints and the hole stage are suggested to be the most important parameters affecting postoperative anatomical and functional success. In 1994, Ryan and Gilbert researched the effect of the duration of complaints on surgical success in macular hole surgery and divided the patients into two groups according to this duration. The writers declared that the rate of macular hole closure was 75% in patients with a complaint duration of less than six months and 60% in those with a complaint duration of more than six months [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA regression analysis performed in 2000 by the Vitrectomy for Macular Hole Study Group included 91 patients and revealed that the preoperative macular hole stage was associated with postoperative visual acuity. In that study, 65.9% of the patients in the stage 2 macular hole group had a postoperative visual acuity of 6/12 or better, while this rate remained at 15.0% for patients with stage 3 or 4 macular holes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn 2003, Kang et al. categorized the postoperative closure of macular holes into two groups: type 1 and type 2. The authors stated that visual acuity was better in those with type 1 closure than in those with type 2 closure [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Unlike the literature, our study demonstrated that among the hole edge parameters examined according to the closure type, a high HFF could be used as a prognostic factor for type 1 closure. Furthermore, among the edge parameters measured by preoperative OCT, the minimum hole diameter, the basal hole diameter, MHI, and THI were found to be higher in type 1 closure cases, although the differences were not statistically significant. Achieving type 1 closure is the most desired postoperative outcome in macular hole surgery. Therefore, we believe that the ability to predict type 1 closure preoperatively is valuable for providing patients with informed expectations.\u003c/p\u003e \u003cp\u003eIn conclusion, the surgical closure of macular holes provides anatomical and functional recovery. The results of this study exhibit that the minimum hole diameter and basal hole diameter, as well as MHI and THI, among the hole edge parameters measured by preoperative OCT, had a significant effect on functional success.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Ahmet Mehmet Somuncu, Mehmet Kola, Hidayet Erd\u0026ouml;l, B\u0026uuml;şra K\u0026ouml;se]. The first draft of the manuscript was written by [Ahmet Mehmet Somuncu, Cenap esen\u0026uuml;lk\u0026uuml;] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to thank b\u0026uuml;şra parlak somuncu for her contribution to the study\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAaberg TM, Blair CJ, Gass JDM (1970) Macular holes. Am J Ophthalmol 69(4):555\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEzra E (2001) Idiopathic full thickness macular hole: Natural history and pathogenesis. Br J Ophthalmol 85:102\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bjo.85.1.102\u003c/span\u003e\u003cspan address=\"10.1136/bjo.85.1.102\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGass JDM (1988) Idiopathic Senile Macular Hole Its Early Stages and Pathogenesis. 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DOI: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1046/j.1442-9071.2000.00329.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1442-9071.2000.00329.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKang SW, Ahn K, Ham DI (2003)Types of macular hole closure and their clinical implications. Br J Ophthalmol 87:1015\u0026ndash;9. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bjo.87.8.1015\u003c/span\u003e\u003cspan address=\"10.1136/bjo.87.8.1015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Macular hole, optical coherence tomography, vitrectomy, retinal layers, visual acuity","lastPublishedDoi":"10.21203/rs.3.rs-4722666/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4722666/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo evaluate the effects of preoperative hole structure and size on postoperative anatomical and functional success in patients with macular holes and determine the changes in retinal layers using optical coherence tomography (OCT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study included 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 six months in the postoperative period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eForty-five patients, 23 (51.1%) female and 22 (48.9%) male, were included in the study.\u003c/p\u003e\n\u003cp\u003eThere was a statistically significant difference between the preoperative visual acuity and the postoperative third-month and sixth-month visual acuity values. After surgery, visual acuity significantly increased for up to six months. When examining the relationship between hole edge parameters and preoperative visual acuity, a negative correlation was detected between the minimum hole diameter, basal hole diameter and the visual acuities measured at the postoperative. The macular hole index (MHI) and The tractional hole index (THI) had a positive correlation with the postoperative visual acuities.\u003c/p\u003e\n\u003cp\u003eThe assessment of the effect of the integrity of the outer limiting membrane (OLM) and the ellipsoid zone (EZ) on postoperative visual acuity at the third and sixth months revealed that visual acuity was higher in patients with OLM and/or EZ integrity at these evaluation times.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe surgical closure of macular holes provides anatomical and functional recovery. This study showed that the minimum hole diameter and basal hole diameter, as well as MHI and THI, among the edge parameters measured by preoperative OCT, had a significant effect on functional success.\u003c/p\u003e","manuscriptTitle":"The Effect of Retinal Structure on Surgical Success in Macular Holes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-11 12:15:27","doi":"10.21203/rs.3.rs-4722666/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"77077162-4d7a-4a21-bfe8-4adc2e6a6e18","owner":[],"postedDate":"August 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-17T13:51:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-11 12:15:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4722666","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4722666","identity":"rs-4722666","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}