Artificial Intelligence and Oct Angiography in Full Thickness Macular Hole. <i>New Developments for Personalized Medicine</i>

Purpose. To study the features in OCT-angiography and microperimetry in eyes with persistent full-thickness macular hole (FTMH) closed with the secondary plana vitrectomy (PPV) with autologous internal limiting membrane (ILM) plug. Methods. Secondary PPV was performed with closing the persistent FTMH with ILM plug, C3F8 tamponade, and face-down positioning. Four patients were followed for 6 months with best corrected visual acuity (BCVA) measurement, SD-OCT and OCT-A, and microperimetry. The results were compared with the fellow eye; in two patients, it was the healthy eye, and in two remaining eyes, successfully closed FTMH after primary PPV. Results. ILM flap was integrated in all cases with V-shape of closure, and atrophy was found in one case, with the largest diameter of FTMH. BCVA improved in two cases and remained the same in two cases. In OCT-A, the area of foveal avascular zone (FAZ) was larger, and foveal vessel density (FVDS) was smaller in eyes after secondary PPV in comparison to fellow eyes. In microperimetry, retinal sensitivity was lower in eyes after secondary PPV, and eccentric fixation was found in 2 of 4 patients. Conclusion. Although the anatomical results of repeated surgeries of FTMH with ILM plug are favorable, visual function results may be limited. Secondary closure of FTMH with ILM plug may lead to atrophy, changes in the macular vasculature, and eccentric fixation. The trial is registered with NCT03701542.

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Artificial Intelligence and OCT Angiography in Full Thickness Macular Hole. New Developments for Personalized Medicine

Diagnostics ◽

10.3390/diagnostics11122319 ◽

2021 ◽

Vol 11 (12) ◽

pp. 2319

Author(s):

Stanislao Rizzo ◽

Alfonso Savastano ◽

Jacopo Lenkowicz ◽

Maria Cristina Savastano ◽

Luca Boldrini ◽

...

Keyword(s):

Artificial Intelligence ◽

Visual Acuity ◽

Macular Hole ◽

Predictive Accuracy ◽

Predictive Performance ◽

Full Thickness ◽

Cross Sectional ◽

Vascular Plexus ◽

Single Center Study ◽

Full Thickness Macular Hole

Purpose: To evaluate the 1-year visual acuity predictive performance of an artificial intelligence (AI) based model applied to optical coherence tomography angiography (OCT-A) vascular layers scans from eyes with a full-thickness macular hole (FTMH). Methods: In this observational cross-sectional, single-center study, 35 eyes of 35 patients with FTMH were analyzed by OCT-A before and 1-year after surgery. Superficial vascular plexus (SVP) and deep vascular plexus (DVP) images were collected for the analysis. AI approach based on convolutional neural networks (CNN) was used to generate a continuous predictive variable based on both SVP and DPV. Different pre-trained CNN networks were used for feature extraction and compared for predictive accuracy. Results: Among the different tested models, the inception V3 network, applied on the combination of deep and superficial OCT-A images, showed the most significant differences between the two obtained image clusters defined in C1 and C2 (best-corrected visual acuity [BCVA] C1 = 49.10 [±18.60 SD] and BCVA C2 = 66.67 [±16.00 SD, p = 0.005]). Conclusions: The AI-based analysis of preoperative OCT-A images of eyes affected by FTMH may be a useful support system in setting up visual acuity recovery prediction. The combination of preoperative SVP and DVP images showed a significant morphological predictive performance for visual acuity recovery.

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Changes in each retinal layer and ellipsoid zone recovery after full-thickness macular hole surgery

Scientific Reports ◽

10.1038/s41598-021-90955-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Min-Woo Lee ◽

Tae-Yeon Kim ◽

Yong-Yeon Song ◽

Seung-Kook Baek ◽

Young-Hoon Lee

Keyword(s):

Macular Hole ◽

Axial Length ◽

Outer Nuclear Layer ◽

Plexiform Layer ◽

Retinal Layer ◽

Inner Plexiform Layer ◽

Full Thickness ◽

Ellipsoid Zone ◽

Full Thickness Macular Hole ◽

Fellow Eyes

AbstractTo analyze the changes in each retinal layer and the recovery of the ellipsoid zone (EZ) after full-thickness macular hole (FTMH) surgery. Patients who underwent surgery for FTMH were included. Spectral-domain optical coherence tomography (SD-OCT) was performed preoperatively and postoperatively at 1, 3, 6, 9, and 12 months. A total of 32 eyes were enrolled. Ganglion cell layer, inner plexiform layer, and inner nuclear layer showed significant reductions over time after surgery (P = 0.020, P = 0.001, and P = 0.001, respectively), but were significantly thicker than those of fellow eyes at 12 months postoperatively. The average recovery duration of the external limiting membrane (ELM), outer nuclear layer (ONL), and EZ was 1.5, 2.1, and 6.1 months, respectively. Baseline best-corrected visual acuity (BCVA) (P = 0.003), minimum linear diameter (MLD) (P = 0.025), recovery of EZ (P = 0.008), and IRL thickness (P < 0.001) were significant factors associated with changes in the BCVA. Additionally, axial length (P < 0.001), MLD (P = 0.020), and IRL thickness (P = 0.001) showed significant results associated with EZ recovery. The IRL gradually became thinner after FTMH surgery but was still thicker than that of the fellow eye at 12 months postoperatively. The recovery of ELM and ONL may be a prerequisite for the EZ recovery. The BCVA change was affected by baseline BCVA, MLD, recovery of EZ, and IRL thickness. Additionally, axial length, MLD, and IRL thickness were significantly associated with EZ recovery.

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Full-thickness macular hole repair with associated asteroid hyalosis

Canadian Journal of Ophthalmology ◽

10.1016/j.jcjo.2021.02.031 ◽

2021 ◽

Author(s):

Saumya M. Shah ◽

Sophie J. Bakri

Keyword(s):

Macular Hole ◽

Full Thickness ◽

Full Thickness Macular Hole ◽

Asteroid Hyalosis

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Development of Stage 4 Macular Hole after Spontaneous Closure in a Patient with Stage 2 Macular Hole and a Lamellar Macular Hole-Associated Epiretinal Proliferation

Case Reports in Ophthalmology ◽

10.1159/000513132 ◽

2021 ◽

pp. 481-484

Author(s):

Masahisa Watanabe ◽

Harumasa Yokota ◽

Hiroshi Aso ◽

Hirotsugu Hanazaki ◽

Junya Hanaguri ◽

...

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Spontaneous Closure ◽

Surgical Removal ◽

Lamellar Macular Hole ◽

Full Thickness ◽

Stage 4 ◽

Full Thickness Macular Hole ◽

The Right ◽

Hole Closure

Herein, we report the longitudinal observation of a case with reopening of the macular hole associated with a lamellar macular hole-associated epiretinal proliferation (LHEP) followed by spontaneous closure in patients with stage 2 idiopathic macular hole. A 64-year-old woman was referred for the decreased visual acuity (VA) and acute anorthopia in the right eye. Funduscopy and optical coherence tomography (OCT) showed stage 2 full-thickness macular hole without posterior vitreous detachment (PVD) and operculum formation. Her best-corrected visual acuity (BCVA) was 20/32. One month later, the diameter of the macular hole was getting small and VA improved. Six months later, the macular hole was treated spontaneously with the attached hyaloid membrane to the macula by OCT and the BCVA improved to 20/20. Fourteen months after the first visit, the BCVA decreased to 20/50 and the patient was diagnosed with stage 4 macular hole with complete PVD. OCT showed full-thickness macular hole with a LHEP in the right eye. After 25G-gauge vitrectomy with the peeling of internal limiting membrane (ILM) and LHEP, the macular hole was closed and BCVA finally improved to 20/25. Spontaneous macular hole closure without PVD may rarely occur in patients with LHEP. The surgical removal of ILM and LHEP may contribute to the successful macular hole closure after vitrectomy.

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