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OCT useful for measuring macular holes before closure surgery
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WAILEA, Hawaii — Using optical coherence tomography to preoperatively measure a macular hole will allow a surgeon to avoid using indocyanine green stain and be more confident in his or her surgical outcomes, a speaker said here.
"If you use the OCT to measure the macular hole and the hole is measuring less than 400 µm, for me, I don't think it's worth the risk of ICG in those cases," Jay S. Duker, MD, said at Retina 2009. "Holes bigger than that, certainly holes that are chronic and holes that have epiretinal membrane — I think the take-home message for me is those are the ones I'm going to continue to use ICG to stain the ILM and try to remove the ILM completely."
The retrospective, non-comparative, interventional case series conducted over 9 months looked at all patients undergoing 23-gauge pars plana vitrectomy without adjuvants for idiopathic macular hole. The researchers used OCT to measure the size of the holes and then conducted 23-gauge pars plana vitrectomy.
The results of 22 eyes showed 20 were successfully closed. Of the successfully closed holes, the mean preoperative OCT size of the macular hole was 243 µm, and of the two unsuccessful cases, mean preop hole size was 436 µm. All eyes with macular holes measuring less than 380 µm were closed.
In looking at other studies in the literature, Dr. Duker said holes less than 400 µm have greater than 92% closure rate, regardless of technique. He concluded that if a macular hole measures less than 400 µm, adjuvants such as ICG may not be necessary.
"I think measuring the hole is very helpful to determine your success rate, and smaller holes close better than bigger holes," he said.