Analysis of choroidal thickness and blood perfusion in idiopathic macular hole eye_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhu Haiyan , Guo Ju , Zhou Pengyi , Jin Bo , Xie Kunpeng , Du Liping ,  Jin Xuemin

Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China;
Zhu Haiyan and Guo Ju are contributed equally to the article;

Corresponding author：

Jin Xuemin, Email: jinxuemin@zzu.edu.cn

Keywords：

Retinal perforations; Tomography, optical coherence; Regional blood flow; Choroidal thickness

DOI：

10.3760/cma.j.cn511434-20210831-00478

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Objective To observe and analyze the macular choroidal thickness and choroidal blood perfusion (CBP) in eyes with idiopathic macular hole (IMH) and their correlation. Methods A cross-sectional observational clinical study. From March 2019 to October 2021, 60 IMH patients with 60 eyes (IMH group) and 60 healthy volunteers with 60 eyes (control group) who consecutively visited Department of Ophthalmology of The First Affiliated Hospital of Zhengzhou University were included in the study. Among the 60 eyes in the IMH group, 8, 8, 15, and 29 eyes were at stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. There was no significant difference in age, spherical equivalent power and axial length between the two groups (t=1.327, 0.157, 0.542; P＞0.05). The average macular choriodal thickness (AMCT) and CBP in different regions of the macular region of the examined eye were measured using a swept-frequency light source optical coherence tomography scanner. According to the zoning method for the treatment of diabetic retinopathy, the choroid within 6 mm of the fovea was divided into 3 concentric circles with the fovea as the center. They are the central area with a diameter of 1 mm, the inner ring area of 1-3 mm, and the outer ring area of 3-6 mm; the inner ring area and the outer ring area were divided into 4 areas by 2 radiations respectively, including the upper part of the inner superior (IS), the lower part of the inner inferior (Ⅱ), and the nasal side of the inner nasal (IN), inner temporal (IT), outer superior (OS), outer inferior (OI), outer nasal (ON), outer temporal (OT), a total of 9 regions. The distribution characteristics of AMCT and CBP in different regions were observed. The correlation between AMCT and CBP was analyzed by Pearson correlation; the correlation between AMCT, CBP and IMH stage was analyzed by Spearman correlation. Results Compared with the eyes of the control group, the AMCT of the affected eyes in the IMH group was significantly thinner in all areas of the macula, and the difference was statistically significant (t=2.378, 4.641, 2.888, 3.390, 3.575, 4.870, 4.077, 4.946, 4.578; P＜0.05). Compared with the control group, the CBP in the OS and OT regions of the affected eyes in the IMH group was significantly lower, the difference was statistically significant (t=3.424, 4.516; P＜0.05). The results of Pearson correlation analysis showed that there was a significant positive correlation between AMCT and CBP in the OT region (r=0.314, P＜0.001). Spearman correlation analysis showed that there was a significant positive correlation between AMCT and IMH staging in each region (r=0.375, 0.374, 0.289, 0.379, 0.441, 0.392, 0.303, 0.341, 0.292; P＜0.05). There was no significant correlation between CBP and IMH staging in IN, OI and OT regions (r=－0.138, －0.016, －0.221; P＞0.05); CBP and IMH staging in other regions were significantly negatively correlated (r=－0.560, －0.390, －0.819, －0.692, －0.329, －0.587; P＜0.05). Conclusions The choroidal thickness in the macular region of the eyes with IMH is significantly thinner than that of the normal subjects; there is choroidal hypoperfusion in local areas. There is a significant positive correlation between local regional AMCT and CBP; IMH stage is higher, the trend of AMCT in each region is thickening, and the CBP in most regions decrease.

Citation： Zhu Haiyan, Guo Ju, Zhou Pengyi, Jin Bo, Xie Kunpeng, Du Liping, Jin Xuemin. Analysis of choroidal thickness and blood perfusion in idiopathic macular hole eye. Chinese Journal of Ocular Fundus Diseases, 2022, 38(9): 755-761. doi: 10.3760/cma.j.cn511434-20210831-00478 Copy

1.	Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Retina, 1988, 106(5): 629-639. DOI: 10.1001/archopht.1988.01060130683026.
2.	Avila MP, Jalkh AE, Murakami K, et al. Biomicroscopic study of the vitreous in macular breaks[J]. Ophthalmology, 1983, 90(11): 1277-1283. DOI: 10.1016/s0161-6420(83)34391-8.
3.	McDonnell PJ, Fine SL, Hillis AI. Clinical features of idiopathic macular cysts and holes[J]. Am J Ophthalmol, 1982, 93(6): 777-786. DOI: 10.1016/0002-9394(82)90474-3.
4.	Morgan CM, Schatz H. Involutional macular thinning. A pre-macular hole condition[J]. Ophthalmology, 1986, 93(2): 153-161. DOI: 10.1016/s0161-6420(86)33767-9.
5.	冷思, 艾明. 特发性黄斑裂孔修复术后黄斑区血流特点[J]. 临床眼科杂志, 2019, 27(5): 408-411. DOI: 10.3969/j.issn.1006-8422.2019.05.006.Leng S, Ai M. Foveal microvasculature features of surgically closed macular hole[J]. J Clin Ophthalmol, 2019, 27(5): 408-411. DOI: 10.3969/j.issn.1006-8422.2019.05.006.
6.	Aras C, Ocakoglu O, Akova N. Foveolar choroidal blood flow in idiopathic macular hole[J]. Int Ophthalmol, 2004, 25(4): 225-231. DOI: 10.1007/s10792-005-5014-4.
7.	季苏娟, 李甦雁, 张正培, 等. 特发性黄斑裂孔患者黄斑部脉络膜厚度的观察[J]. 中国中医眼科杂志, 2014, 24(5): 342-344. DOI: 10.13444/j.cnki.zgzyykzz.003337.Ji SJ, Li SY, Zhang ZP, et al. Observation of the macular choroidal thickness in patients with idiopathic macular hole[J]. China Journal of Chinese Ophthalmology, 2014, 24(5): 342-344. DOI: 10.13444/j.cnki.zgzyykzz.003337.
8.	陈迪, 李略, 杨治坤, 等. 频域光学相干断层扫描观察特发性黄斑裂孔患者脉络膜厚度[J]. 协和医学杂志, 2013, 4(2): 113-117. DOI: 10.3969/j.issn.1674-9081.2013.02.006.Chen D, Li L, Yang ZK. Spectral-domain optical coherence tomography findings of choroidal thickness in eyes of patients with idiopathic macular holes[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(2): 113-117. DOI: 10.3969/j.issn.1674-9081.2013.02.006.
9.	Spaide RF, Koizumi H, Pozzoni MC. Enhanced depth imaging spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2008, 146(4): 496-500. DOI: 10.1136/bcr-2021-248109.
10.	Copete S, Flores-Moreno I, Montero JA, et al. Direct comparison of spectral-domain and swept-source OCT in the measurement of choroidal thickness in normal eyes[J]. Br J Ophthalmol, 2014, 98(3): 334-338. DOI: 10.1136/bjophthalmol-2013-303904.
11.	Bertelmann T, Blum M, Kunert K, et al. Foveal pit morphology evaluation during optical biometry measurements using a full-eye-length swept-source OCT scan biometer prototype[J]. Eur J Ophthalmol, 2015, 25(6): 552-558. DOI: 10.5301/ejo.5000630.
12.	Ruiz-Medrano J, Flores-Moreno I, Peña-García P, et al. Asymmetry in macular choroidal thickness profile between both eyes in a healthy population measured by swept-source optical coherence tomography[J]. Retina, 2015, 35(10): 2067-2073. DOI: 10.1097/IAE.0000000000000590.
13.	Nagaoka T. Physiological mechanism for the regulation of ocular circulation[J]. Nippon Ganka Gakkai Zasshi, 2006, 110(11): 872-878.
14.	Sadda SR, Abdelfattah NS, Lei J, et al. Spectral-domain OCT analysis of risk factors for macular atrophy development in the HARBOR study for neovascular age-related macular degeneration[J]. Ophthalmology, 2020, 127(10): 1360-1370. DOI: 10.1016/j.ophtha.2020.03.031.
15.	Parisi V, Ziccardi L, Costanzo E, et al. Macular functional and morphological changes in intermediate age-related maculopathy[J]. Invest Ophthalmol Vis Sci, 2020, 61(5): 11. DOI: 10.1167/iovs.61.5.11.
16.	Sahoo NK, Mandadi S, Singh SR, et al. Longitudinal changes in fellow eyes of choroidal neovascularization associated with central serous chorioretinopathy: optical coherence tomography angiography study[J]. Eur J Ophthalmol, 2021, 31(4): 1892-1898. DOI: 10.1177/1120672120952678.
17.	Wang E, Zhao X, Yang J, et al. Visualization of deep choroidal vasculatures and measurement of choroidal vascular density: a swept-source optical coherence tomography angiography approach[J/OL]. BMC Ophthalmol, 2020, 20(1): 321[2020-08-05]. https://pubmed.ncbi.nlm.nih.gov/32758186/. DOI: 10.1186/s12886-020-01591-x.
18.	郁艳萍, 刘武. 脉络膜厚度与特发性黄斑裂孔和黄斑前膜关系的研究进展[J]. 眼科新进展, 2016, 36(9): 898-900. DOI: 10.13389/j.cnki.rao.2016.0241.Yu YP, Liu W. Research progress on relationship between choroidal thickness and idiopathic macular hole, epiretinal membrane[J]. Rec Adv Ophthalmol, 2016, 36(9): 898-900. DOI: 10.13389/j.cnki.rao.2016.0241.
19.	Reibaldi M, Boscia F, Avitabile T, et al. Enhanced depth imaging optical coherence tomography of the choroid in idiopathic macular hole: a cross-sectional prospective study[J]. Am J Ophthalmol, 2011, 151(1): 112-117. DOI: 10.1016/j.ajo.2010.07.004.
20.	Zhang P, Zhou M, Wu Y, et al. Choroidal thickness in unilateral idiopathic macular hole: a cross-sectional study and meta-analysis[J]. Retina, 2017, 37(1): 60-69. DOI: 10.1097/IAE.0000000000001118.
21.	Zeng J, Li J, Liu R, et al. Choroidal thickness in both eyes of patients with unilateral idiopathic macular hole[J]. Ophthalmology, 2012, 119(11): 2328-2333. DOI: 10.1016/j.ophtha.2012.06.008.
22.	Bardak H, Gunay M, Bardak Y, et al. Retinal and choroidal thicknesses measured with swept-source optical coherence tomography after surgery for idiopathic macular hole[J]. Eur J Ophthalmol, 2017, 27(3): 312-318. DOI: 10.5301/ejo.5000851.
23.	Zhang Z, Qi Y, Wei W, et al. Investigation of macular choroidal thickness and blood flow change by optical coherence tomography angiography after posterior scleral reinforcement[J/OL]. Front Med (Lausanne), 2021, 8: 658259[2021-04-29]. https://pubmed.ncbi.nlm.nih.gov/34017847/. DOI: 10.3389/fmed.2021.658259.
24.	Sul S, Gurelik G, Korkmaz Ş, et al. Choroidal thickness in macular holes[J]. Int Ophthalmol, 2019, 39(11): 2595-2601. DOI: 10.1007/s10792-019-01108-6.
25.	Gaudric A, Haouchine B, Massin P, et al. Macular hole formation: new data provided by optical coherence tomography[J]. Arch Ophthalmol, 1999, 117(6): 744-751. DOI: 10.1001/archopht.117.6.744.
26.	Gallego-Pinazo R, Dolz-Marco R, Gómez-Ulla F, et al. Pachychoroid diseases of the macula[J]. Med Hypothesis Discov Innov Ophthalmol, 2014, 3(4): 111-115.
27.	Nkrumah G, Maltsev DS, Manuel PA, et al. Current choroidal imaging findings in central serous chorioretinopathy[J]. Vision (Basel), 2020, 4(4): 44. DOI: 10.3390/vision4040044.
28.	Agrawal R, Chhablani J, Tan KA, et al. Choroidal vascularity index in central serous chorioretinopathy[J]. Retina, 2016, 36(9): 1646-1651. DOI: 10.1097/IAE.0000000000001040.

1. Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Retina, 1988, 106(5): 629-639. DOI: 10.1001/archopht.1988.01060130683026.
2. Avila MP, Jalkh AE, Murakami K, et al. Biomicroscopic study of the vitreous in macular breaks[J]. Ophthalmology, 1983, 90(11): 1277-1283. DOI: 10.1016/s0161-6420(83)34391-8.
3. McDonnell PJ, Fine SL, Hillis AI. Clinical features of idiopathic macular cysts and holes[J]. Am J Ophthalmol, 1982, 93(6): 777-786. DOI: 10.1016/0002-9394(82)90474-3.
4. Morgan CM, Schatz H. Involutional macular thinning. A pre-macular hole condition[J]. Ophthalmology, 1986, 93(2): 153-161. DOI: 10.1016/s0161-6420(86)33767-9.
5. 冷思, 艾明. 特发性黄斑裂孔修复术后黄斑区血流特点[J]. 临床眼科杂志, 2019, 27(5): 408-411. DOI: 10.3969/j.issn.1006-8422.2019.05.006.Leng S, Ai M. Foveal microvasculature features of surgically closed macular hole[J]. J Clin Ophthalmol, 2019, 27(5): 408-411. DOI: 10.3969/j.issn.1006-8422.2019.05.006.
6. Aras C, Ocakoglu O, Akova N. Foveolar choroidal blood flow in idiopathic macular hole[J]. Int Ophthalmol, 2004, 25(4): 225-231. DOI: 10.1007/s10792-005-5014-4.
7. 季苏娟, 李甦雁, 张正培, 等. 特发性黄斑裂孔患者黄斑部脉络膜厚度的观察[J]. 中国中医眼科杂志, 2014, 24(5): 342-344. DOI: 10.13444/j.cnki.zgzyykzz.003337.Ji SJ, Li SY, Zhang ZP, et al. Observation of the macular choroidal thickness in patients with idiopathic macular hole[J]. China Journal of Chinese Ophthalmology, 2014, 24(5): 342-344. DOI: 10.13444/j.cnki.zgzyykzz.003337.
8. 陈迪, 李略, 杨治坤, 等. 频域光学相干断层扫描观察特发性黄斑裂孔患者脉络膜厚度[J]. 协和医学杂志, 2013, 4(2): 113-117. DOI: 10.3969/j.issn.1674-9081.2013.02.006.Chen D, Li L, Yang ZK. Spectral-domain optical coherence tomography findings of choroidal thickness in eyes of patients with idiopathic macular holes[J]. Medical Journal of Peking Union Medical College Hospital, 2013, 4(2): 113-117. DOI: 10.3969/j.issn.1674-9081.2013.02.006.
9. Spaide RF, Koizumi H, Pozzoni MC. Enhanced depth imaging spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2008, 146(4): 496-500. DOI: 10.1136/bcr-2021-248109.
10. Copete S, Flores-Moreno I, Montero JA, et al. Direct comparison of spectral-domain and swept-source OCT in the measurement of choroidal thickness in normal eyes[J]. Br J Ophthalmol, 2014, 98(3): 334-338. DOI: 10.1136/bjophthalmol-2013-303904.
11. Bertelmann T, Blum M, Kunert K, et al. Foveal pit morphology evaluation during optical biometry measurements using a full-eye-length swept-source OCT scan biometer prototype[J]. Eur J Ophthalmol, 2015, 25(6): 552-558. DOI: 10.5301/ejo.5000630.
12. Ruiz-Medrano J, Flores-Moreno I, Peña-García P, et al. Asymmetry in macular choroidal thickness profile between both eyes in a healthy population measured by swept-source optical coherence tomography[J]. Retina, 2015, 35(10): 2067-2073. DOI: 10.1097/IAE.0000000000000590.
13. Nagaoka T. Physiological mechanism for the regulation of ocular circulation[J]. Nippon Ganka Gakkai Zasshi, 2006, 110(11): 872-878.
14. Sadda SR, Abdelfattah NS, Lei J, et al. Spectral-domain OCT analysis of risk factors for macular atrophy development in the HARBOR study for neovascular age-related macular degeneration[J]. Ophthalmology, 2020, 127(10): 1360-1370. DOI: 10.1016/j.ophtha.2020.03.031.
15. Parisi V, Ziccardi L, Costanzo E, et al. Macular functional and morphological changes in intermediate age-related maculopathy[J]. Invest Ophthalmol Vis Sci, 2020, 61(5): 11. DOI: 10.1167/iovs.61.5.11.
16. Sahoo NK, Mandadi S, Singh SR, et al. Longitudinal changes in fellow eyes of choroidal neovascularization associated with central serous chorioretinopathy: optical coherence tomography angiography study[J]. Eur J Ophthalmol, 2021, 31(4): 1892-1898. DOI: 10.1177/1120672120952678.
17. Wang E, Zhao X, Yang J, et al. Visualization of deep choroidal vasculatures and measurement of choroidal vascular density: a swept-source optical coherence tomography angiography approach[J/OL]. BMC Ophthalmol, 2020, 20(1): 321[2020-08-05]. https://pubmed.ncbi.nlm.nih.gov/32758186/. DOI: 10.1186/s12886-020-01591-x.
18. 郁艳萍, 刘武. 脉络膜厚度与特发性黄斑裂孔和黄斑前膜关系的研究进展[J]. 眼科新进展, 2016, 36(9): 898-900. DOI: 10.13389/j.cnki.rao.2016.0241.Yu YP, Liu W. Research progress on relationship between choroidal thickness and idiopathic macular hole, epiretinal membrane[J]. Rec Adv Ophthalmol, 2016, 36(9): 898-900. DOI: 10.13389/j.cnki.rao.2016.0241.
19. Reibaldi M, Boscia F, Avitabile T, et al. Enhanced depth imaging optical coherence tomography of the choroid in idiopathic macular hole: a cross-sectional prospective study[J]. Am J Ophthalmol, 2011, 151(1): 112-117. DOI: 10.1016/j.ajo.2010.07.004.
20. Zhang P, Zhou M, Wu Y, et al. Choroidal thickness in unilateral idiopathic macular hole: a cross-sectional study and meta-analysis[J]. Retina, 2017, 37(1): 60-69. DOI: 10.1097/IAE.0000000000001118.
21. Zeng J, Li J, Liu R, et al. Choroidal thickness in both eyes of patients with unilateral idiopathic macular hole[J]. Ophthalmology, 2012, 119(11): 2328-2333. DOI: 10.1016/j.ophtha.2012.06.008.
22. Bardak H, Gunay M, Bardak Y, et al. Retinal and choroidal thicknesses measured with swept-source optical coherence tomography after surgery for idiopathic macular hole[J]. Eur J Ophthalmol, 2017, 27(3): 312-318. DOI: 10.5301/ejo.5000851.
23. Zhang Z, Qi Y, Wei W, et al. Investigation of macular choroidal thickness and blood flow change by optical coherence tomography angiography after posterior scleral reinforcement[J/OL]. Front Med (Lausanne), 2021, 8: 658259[2021-04-29]. https://pubmed.ncbi.nlm.nih.gov/34017847/. DOI: 10.3389/fmed.2021.658259.
24. Sul S, Gurelik G, Korkmaz Ş, et al. Choroidal thickness in macular holes[J]. Int Ophthalmol, 2019, 39(11): 2595-2601. DOI: 10.1007/s10792-019-01108-6.
25. Gaudric A, Haouchine B, Massin P, et al. Macular hole formation: new data provided by optical coherence tomography[J]. Arch Ophthalmol, 1999, 117(6): 744-751. DOI: 10.1001/archopht.117.6.744.
26. Gallego-Pinazo R, Dolz-Marco R, Gómez-Ulla F, et al. Pachychoroid diseases of the macula[J]. Med Hypothesis Discov Innov Ophthalmol, 2014, 3(4): 111-115.
27. Nkrumah G, Maltsev DS, Manuel PA, et al. Current choroidal imaging findings in central serous chorioretinopathy[J]. Vision (Basel), 2020, 4(4): 44. DOI: 10.3390/vision4040044.
28. Agrawal R, Chhablani J, Tan KA, et al. Choroidal vascularity index in central serous chorioretinopathy[J]. Retina, 2016, 36(9): 1646-1651. DOI: 10.1097/IAE.0000000000001040.

Chinese Journal of Ocular Fundus Diseases

Analysis of choroidal thickness and blood perfusion in idiopathic macular hole eye

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