Funktionelle und morphologische Korrelationen in der Makulaforamen-Chirurgie

Zusammenfassung

Hintergrund: Ziel der Studie ist die Korrelation von funktionellen und morphologischen Aspekten vor und 12 Monate nach Makulaforamen-Chirurgie. Methoden: In dieser prospektiven, interventionellen, konsekutiven Studie wurde bei 16 Augen von 16 Patienten nach Erstdiagnose und maximaler Symptomendauer von 2 Monaten eine erfolgreiche transkonjunktivale 23-gauge-Vitrektomie mit ILM-Peeling durchgeführt. Präoperativ sowie 3, 6 und 12 Monate postoperativ erfolgte die Bestimmung des bestkorrigierten Visus (logMAR), eine 10° Mikroperimetrie (MP-1) sowie eine Spektral-Domain basierte optische Kohärenztomografie (SD-OCT) Untersuchung. Die Photorezeptorenschicht (Inneres und Äußeres Segment, IS/OS) wurde anhand der SD-OCT-Bilder gewertet und mit den Daten der Mikroperimetrieanalyse in der fovealen und parafovealen Region korreliert. Ergebnisse: Nach 3 Monaten zeigte sich bereits eine Stabilisierung des bestkorrigierten Visus mit Regeneration der IS/OS-Linie sowie eine Besserung des Fixationsverhaltens als auch der Sensitivität im Makulabereich. Nach 12 Monaten kam es zu einer signifikanten Restitution der IS/OS-Linie. Die bestkorrigierte Sehschärfe, die mittlere Gesamtsensitivität sowie die Fixation verbesserten sich signifikant innerhalb des 12-monatigen Beobachtungszeitraums (p < 0,05). Ein Vergleich von Patienten mit einem Visusgewinn von mindestens 2 Zeilen und Patienten mit einem Visusgewinn von weniger als 2 Zeilen, 12 Monate nach der Operation, zeigte keinen statistisch signifikanten Unterschied hinsichtlich der Regeneration der IS/OS-Integrität in der Fovea (p = 0,433), dafür aber in der parafovealen Region. Ein postoperativer Visusgewinn von mindestens 2 Zeilen war signifikant häufiger zu sehen in Augen mit einer postoperativ durchgängigen IS/OS-Linie in den parafovealen Sektoren im Vergleich mit Augen mit persistierenden IS/OS-Defekten (p < 0.02). Schlussfolgerung: Korrelierende morphologische und funktionelle Verbesserungen können nach Durchführung einer erfolgreichen mikroinvasiven Makulaforamenchirurgie beobachtet werden. Das präoperative Ausmaß des IS/OS-Defekts, insbesondere der parafovealen Region, ist ein guter prädiktiver Parameter für die postoperativ gewonnene Makulasensitivität. Die Vorhersage des postoperativen Visusergebnisses sollte daher nicht anhand einer einzigen klinisch, anatomischen Befundung getroffen werden.

Abstract

Background: The purpose of this study is to establish the correlation between functional and morphological aspects before and 12 months after macular hole surgery. Methods: In this prospective, interventional, consecutive study 16 eyes of 16 patients were included. All eyes received a successful transconjunctival 23-gauge vitrectomy with ILM peeling after initial diagnosis and maximum duration of symptoms of two months. Preoperatively and 3, 6 and 12 months postoperatively determinations of best-corrected visual acuity (logMAR), a 10° microperimetry (MP-1) and a spectral-domain based optical coherence tomography (SD-OCT) examination were performed. The photoreceptor layer (inner and outer segment, IS/OS) was evaluated based on SD-OCT images and correlated with data assessed by microperimetry analysis in the foveal and parafoveal region. Results: After three months a stabilisation of BCVA with regeneration of the IS/OS line, an improvement of the fixation behaviour and the macular sensitivity could be observed. A significant restitution of the IS/OS line was observed after 12 months. Best corrected visual acuity, mean overall macular sensitivity and fixation improved significantly within the twelve month observation period (p < 0.05). Comparison of patients with at least two lines of visual acuity gain with patients having less than two lines of visual acuity gain 12 months after surgery showed no statistically significant difference in regeneration of the IS/OS integrity in the fovea (p = 0.433), but a difference was seen in the parafoveal region. A postoperative visual acuity gain of at least two lines was significantly more often seen in eyes with postoperative continuous IS/OS line in the parafoveal sectors compared to eyes with persistent IS/OS defects (p < 0.02). Conclusion: Correlations of morphological and functional improvements can be observed after successful micro-invasive macular hole surgery. The extent of the preoperative IS/OS defect, particularly in the parafoveal region, is a good predictive parameter for the postoperatively obtained macular sensitivity. The prediction of the postoperative visual acuity should not be made on the basis of a single clinical, anatomic finding.

Schlüsselwörter

Retina - SD-OCT - Makulaforamen - Photorezeptoren - Mikroperimetrie - IS/OS

Key words

retina - SD-OCT - macular hole - photoreceptors - microperimetry - IS/OS

• Literatur

• 1 Gass JD. Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol 1988; 106: 629-639
• 2 Tornambe PE. The evolution of macular hole surgery twenty years after its original description. Am J Ophthalmol 2009; 147: 954-956
• 3 Kampik A. Pathology of epiretinal membrane, idiopathic macular hole, and vitreomacular traction syndrome. Retina 2012; 32 (Suppl. 02) S194-S198
• 4 Benson WE, Cruickshanks KC, Fong DS et al. Surgical management of macular holes: a report by the American Academy of Ophthalmology. Ophthalmology 2001; 108: 1328-1335
• 5 Haritoglou C, Neubauer AS, Reiniger IW et al. Long-term functional outcome of macular hole surgery correlated to optical coherence tomography measurements. Clin Experiment Ophthalmol 2007; 35: 208-213
• 6 Haritoglou C, Reiniger IW, Schaumberger M et al. Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane: update of a prospective study. Retina 2006; 26: 618-622
• 7 Itoh Y, Inoue M, Rii T et al. Significant correlation between visual acuity and recovery of foveal cone microstructures after macular hole surgery. Am J Ophthalmol 2012; 153: 111-119
• 8 Shimozono M, Oishi A, Hata M et al. Restoration of the photoreceptor outer segment and visual outcomes after macular hole closure: spectral-domain optical coherence tomography analysis. Graefes Arch Clin Exp Ophthalmol 2011; 249: 1469-1476
• 9 Chung H, Shin CJ, Kim JG et al. Correlation of microperimetry with fundus autofluorescence and spectral-domain optical coherence tomography in repaired macular holes. Am J Ophthalmol 2011; 151: 128-136
• 10 Wakabayashi T, Fujiwara M, Sakaguchi H et al. Foveal microstructure and visual acuity in surgically closed macular holes: spectral-domain optical coherence tomographic analysis. Ophthalmology 2010; 117: 1815-1824
• 11 Oh J, Smiddy WE, Flynn Jr. HW et al. Photoreceptor inner/outer segment defect imaging by spectral domain OCT and visual prognosis after macular hole surgery. Invest Ophthalmol Vis Sci 2010; 51: 1651-1658
• 12 Shiono A, Kogo J, Klose G et al. Photoreceptor outer segment length: a prognostic factor for Idiopathic epiretinal membrane surgery. Ophthalmology 2013; DOI: 10.1016/j.ophtha.2012.09.044.
• 13 Zhou J, Liu W, Li Q et al. [A comparative study of macular thickness and function before and after idiopathic macular epiretinal membrane surgery]. Zhonghua Yan Ke Za Zhi 2012; 48: 119-123
• 14 Shimozono M, Oishi A, Hata M et al. The significance of cone outer segment tips as a prognostic factor in epiretinal membrane surgery. Am J Ophthalmol 2012; 153: 698-704
• 15 Spaide RF, Curcio CA. Anatomical correlates to the bands seen in the outer retina by optical coherence tomography: literature review and model. Retina 2011; 31: 1609-1619
• 16 Hartmann KI, Bartsch DU, Cheng L et al. Scanning laser ophthalmoscope imaging stabilized microperimetry in dry age-related macular degeneration. Retina 2011; 31: 1323-1331
• 17 Mitamura Y, Hirano K, Baba T et al. Correlation of visual recovery with presence of photoreceptor inner/outer segment junction in optical coherence images after epiretinal membrane surgery. Br J Ophthalmol 2009; 93: 171-175
• 18 Sandali O, Basli E, Borderie V et al. [Recurrence of an idiopathic vasocentric epiretinal membrane: clinical and surgical particularities]. J Fr Ophtalmol 2012; 35: 48
• 19 Maier MM, Rass S, Mueller C et al. [Transconjunctival Sutureless Pars Plana Vitrectomy and Brilliant Peel (BP)-Assisted ILM Peeling in Patients with Macular Holes.]. Klin Monbl Augenheilkd 2013; DOI: 10.1055/s-0032-1328510.
• 20 Ruiz-Moreno JM, Arias L, Araiz J et al. Spectral-domain optical coherence tomography study of macular structure as prognostic and determining factor for macular hole surgery outcome. Retina 2013; DOI: 10.1097/IAE.0b013e318285cc3b.
• 21 Parravano M, Oddone F, Boccassini B et al. Functional and structural assessment of lamellar macular holes. Br J Ophthalmol 2013; 97: 291-296
• 22 Nukada K, Hangai M, Ooto S et al. Tomographic features of macula after successful macular hole surgery. Invest Ophthalmol Vis Sci 2013; 54: 2417-2428
• 23 Inoue M, Arakawa A, Yamane S et al. Long-term outcome of macular microstructure assessed by optical coherence tomography in eyes with spontaneous resolution of macular hole. Am J Ophthalmol 2012; 153: 687-691
• 24 Rosa Jr. RH, Glaser BM, de la Cruz Z et al. Clinicopathologic correlation of an untreated macular hole and a macular hole treated by vitrectomy, transforming growth factor-beta 2, and gas tamponade. Am J Ophthalmol 1996; 122: 853-863
• 25 Funata M, Wendel RT, de la Cruz Z et al. Clinicopathologic study of bilateral macular holes treated with pars plana vitrectomy and gas tamponade. Retina 1992; 12: 289-298
• 26 Mayer WJ, Vogel M, Neubauer A et al. Pars plana vitrectomy and internal limiting membrane peeling in epimacular membranes: correlation of function and morphology across the macula. Ophthalmologica 2013; 230: 9-17
• 27 Oh IK, Oh J, Yang SM et al. Hyperreflective external limiting membranes after successful macular hole surgery. Retina 2012; 32: 760-766
• 28 Landa G, Gentile RC, Garcia PM et al. External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis. Eye (Lond) 2012; 26: 61-69