Intact ELMs, normal FAF patterns help predict BCVA after macular hole repair

Intact external limiting membranes and normal hypofluorescence patterns most accurately predicted postoperative visual acuity after vitrectomy for idiopathic macular holes, according to a study.

Perspective from Lars Freisberg, MD

The retrospective study included 77 eyes of 75 patients with an average age of 57.8 years who underwent vitrectomy for idiopathic macular holes.

Investigators performed fundus autofluorescence (FAF) imaging and spectral-domain optical coherence tomography for up to 12 months postoperatively. The primary outcome measures were macular hole size, FAF patterns, OCT retinal outer segment and best corrected visual acuity.

Thirty-seven eyes had intact external limiting membranes (ELMs); 12 of those eyes had normal hypofluorescence, six had homogenous hyperfluoresence and 19 had patchy hyperfluorescence.

BCVA was significantly better in patients with intact ELMs than in patients without intact ELMs (P < .001). Patients who had both intact ELMs and normal FAF patterns (P = .011) also had better BCVA.

Disclosure: The study authors report no relevant financial disclosures.

Perspective

Lars Freisberg, MD

This paper attempts to help the at-times frustrated retina surgeon provide a tool for gauging patient expectations. Unfortunately, it is a retrospective study and secondly, it does not give us additional advice into a preoperative prognostication of best corrected visual acuity. Only a month after the fact can we now assert that function follows form. An intact external limiting membrane and a “normal” hypofluorescence pattern 1 month after surgery predict the group with highest level of visual recovery. By this time in clinical practice we often know how the patient is going to fare by their BCVA compared to preop vision.
Unfortunately, there was no correlation with preoperative functional parameters that could guide us who would be in that desired group, so we could preoperatively direct patient expectations. The study does provide us the ability to relate to patients what they can expect after the fact and help us guide expectations in those who may still improve after more than 1 month, namely those with an intact ELM and a favorable hypoflourescence pattern. As a general tool, though, this may be insufficient.

Lars Freisberg, MD

Tulsa, Okla.

Disclosures: Freisberg has no relevant financial disclosures.

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Source:

Am J Ophthalmol. 2013;156(1):149-156.