Comparison of different measure methods of macular hole closure index for predicting the anatomical prognosis of idiopathic macular hole surgery_Chinese Journal of Ocular Fundus Diseases

Authors：

Yao Yuou ,  Zhao Mingwei , Dong Chongya , Li Xiaoxin , Yin Hong , Liang Jianhong , Liu Peipei , Qu Jinfeng

Department of Ophthalmology, Peking University People’s Hospital, College of Optometry, Beijing Key Laboratory for the Diagnosis and Treatment of Retinal and Choroid Diseases, Beijing 100044, China;

Corresponding author：

Zhao Mingwei, Email: zhaomingwei@medmail.com.cn

Keywords：

Retinal perforations/surgery; Tomography, optical coherence; Forecasting

DOI：

10.3760/cma.j.issn.1005-1015.2017.04.004

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Objective To compare the predicted efficiency of macular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery. Methods This is a prospective exploratory clinical study. A total of 63 patients (63 eyes) with idiopathic MH, who received vitrectomy, inner limiting membrane peeling and gas tamponade, were enrolled in this study. All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI=（M+N）/BASE, M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole, respectively. BASE is the length of MH base. MHCI1 was measured by built-in caliper of OCT software, MHCI2 was measured by ImageJ software. The minimum macular diameter (MHD) was measured by built-in caliper of OCT software. Based on the OCT images, the anatomical outcomes were classified grade A (bridge-like shape closure), grade B (complete closure) and grade C (poor closure). Grade A and B are considered as good closure, grade C as poor closure. Patients were followed up at 3, 6 and 12 months after surgery. The closure grades at last visit were the final outcome. The relationship between MHCI1, MHCI2 and closure grades was analyzed. And the predicted efficiency of MHD, MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied. Results The mean MHCI1 was 0.68±0.21 (0.30-1.35), MHCI2 was 0.95±0.26 (0.41-1.55), and MHD was (476.24±210.18) μm (127-956 μm). MHCI1 and MHCI2 were both negative correlated with the closure grades (r=−0.665, −0.691; P＜0.001). The receiver operating characteristic (ROC) curve analysis of MHCI1, MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928, 0.957 and 0.916 respectively, and 0.505, 0.67 and 559 μm were set as the lower cut-off value. The sensitivity was 96.2%, 92.3% and 90.9% respectively, and specificity was 81.8%, 72.7% and 76.9% respectively. Accordingly, the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840, 0.847 and 0.653 respectively, and 0.705, 0.965 and 364 μm were set as the upper cut-off value. The sensitivity was 80.0%, 82.9%, 63.4% respectively and specificity was 75.0%, 85.7%, 65.9%. Conclusion MHCI1 and MHCI2, measured by built-in caliper of OCT software or ImageJ software, both have good predictive efficiency for the anatomical outcomes of MH surgery.

Citation： Yao Yuou, Zhao Mingwei, Dong Chongya, Li Xiaoxin, Yin Hong, Liang Jianhong, Liu Peipei, Qu Jinfeng. Comparison of different measure methods of macular hole closure index for predicting the anatomical prognosis of idiopathic macular hole surgery. Chinese Journal of Ocular Fundus Diseases, 2017, 33(4): 341-345. doi: 10.3760/cma.j.issn.1005-1015.2017.04.004 Copy

1.	Lois N, Burr J, Norrie J, et al. Clinical and cost-effectiveness of internal limiting membrane peeling for patients with idiopathic full thickness macular hole: protocol for a Randomised Controlled Trial: FILMS (Full-thickness macular hole and Internal Limiting Membrane peeling Study)[J]. Trials, 2008, 9(1): 61. DOI: 10.1186/1745-6215-9-61.
2.	Passemard M, Yakoubi Y, Muselier A, et al. Long-term outcome of idiopathic macular hole surgery[J]. Am J Ophthalmol, 2010, 149(1): 120-126. DOI: 10.1016/j.ajo.2009.08.003.
3.	Mochizuki N, Yamamoto T, Enaida H, et al. Long-term outcomes of 3 surgical adjuvants used for internal limiting membrane peeling in idiopathic macular hole surgery[J]. Jpn J Ophthalmol, 2014, 58(6): 455-461. DOI: 10.1007/s10384-014-0345-1.
4.	Ip MS, Baker BJ, Duker JS, et al. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography[J]. Arch Ophthalmol, 2002, 120(1): 29-35.
5.	Kusuhara S, Teraoka Escaño MF, Fujii S, et al. Prediction of postoperative visual outcome based on hole configuration by optical coherence tomography in eyes with idiopathic macular holes[J]. Am J Ophthalmol, 2004, 138(5): 709-716. DOI: 10.1016/j.ajo.2004.04.063.
6.	Kiernan DF, Mieler WF, Hariprasad SM. Spectral-domain optical coherence tomography: a comparison of modern high-resolution retinal imaging systems[J]. Am J Ophthalmol, 2010, 149(1): 18-31. DOI: 10.1016/j.ajo.2009.08.037.
7.	Liu P, Sun Y, Dong C, et al. A new method to predict anatomical outcome after idiopathic macular hole surgery[J]. Graefe’s Arch Clin Exp Ophthalmol, 2016, 254(4): 683-688. DOI: 10.1007/s00417-015-3116-x.
8.	Armitage P, Colton T. Receiver operating characteristics (ROC) curves[M]//Armitage P, Colton T. Encyclopedia of biostatistics. New York: John, 1998: 3737-3744.
9.	余松林. 诊断试验的评价[M]//余松林.医学统计学[M].北京: 人民卫生出版社, 2002: 164-178.Yu SL. Evaluation of diagnostic test[M]//Yu SL. Medical statistics. Beijing: People’s Medical Publishing House, 2002: 164-178.
10.	Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests[J]. Prev Vet Med, 2000, 45(1-2): 23-41.
11.	Hajian-Tilaki K. Receiver operating characteristic (ROC) curve an alysis for medical diagnostic test evaluation[J].Caspian J Intern Med, 2013, 4(2): 627-635.
12.	Ip MS, Baker BJ, Duker JS, et al. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography[J]. Arch Ophthalmol, 2002, 120(1): 29-35.
13.	Hejsek L, Dusova J, Stepanov A, et al. Re-operation of idiopathic macular hole after failed initial surgery[J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2014, 158(4): 596-599. DOI: 10.5507/bp.2013.088.
14.	Jaycock PD, Bunce C, Xing W et al. Outcomes of macular hole surgery: implications for surgical management and clinical governance[J]. Eye (Lond), 2005, 19(8): 879-884. DOI: 10.1038/sj.eye.6701679.
15.	Goker YS, Koc M, Yuksel K, et al. Relationship between peeled internal limiting membrane area and anatomic outcomes following macular hole surgery: a quantitative analysis[J/OL]. J Ophthalmol, 2016, 2016: 5641273[2016-06-16]. https://dx.doi.org/10.1155/2016/5641273. DOI: 10.1155/2016/5641273.
16.	Raymond I, Kapoor KG. No face-down positioning and broad internal limiting membrane peeling in the surgical repair of idiopathic macular holes[J]. Ophthalmology, 2013, 120(10): 1998-2003. DOI: 10.1016/j.ophtha.2013.06.001.
17.	Carnevali A, Cicinelli MV, Capuano V, et al. Extent of internal limiting membrane peeling and its impact on macular hole surgery outcomes: a randomized trial[J]. Am J Ophthalmol, 2016, 169: 179-188. DOI: 10.1016/j.ajo.2016.06.041.
18.	Haritoglou C, Gass CA, Schaumberger M, et al. Macular changes after peeling of the internal limiting membrane in macular hole surgery[J]. Am J Ophthalmol, 2001, 132(3): 363-368.
19.	Modi A, Giridhar A, Gopalakrishnan M. Comparative analysis of outcomes with variable diameter internal limiting membrane peeling in surgery for idiopathic macular hole repair[J]. Retina, 2017, 37(2): 265-273. DOI: 10.1097/IAE.0000000000001123.

1. Lois N, Burr J, Norrie J, et al. Clinical and cost-effectiveness of internal limiting membrane peeling for patients with idiopathic full thickness macular hole: protocol for a Randomised Controlled Trial: FILMS (Full-thickness macular hole and Internal Limiting Membrane peeling Study)[J]. Trials, 2008, 9(1): 61. DOI: 10.1186/1745-6215-9-61.
2. Passemard M, Yakoubi Y, Muselier A, et al. Long-term outcome of idiopathic macular hole surgery[J]. Am J Ophthalmol, 2010, 149(1): 120-126. DOI: 10.1016/j.ajo.2009.08.003.
3. Mochizuki N, Yamamoto T, Enaida H, et al. Long-term outcomes of 3 surgical adjuvants used for internal limiting membrane peeling in idiopathic macular hole surgery[J]. Jpn J Ophthalmol, 2014, 58(6): 455-461. DOI: 10.1007/s10384-014-0345-1.
4. Ip MS, Baker BJ, Duker JS, et al. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography[J]. Arch Ophthalmol, 2002, 120(1): 29-35.
5. Kusuhara S, Teraoka Escaño MF, Fujii S, et al. Prediction of postoperative visual outcome based on hole configuration by optical coherence tomography in eyes with idiopathic macular holes[J]. Am J Ophthalmol, 2004, 138(5): 709-716. DOI: 10.1016/j.ajo.2004.04.063.
6. Kiernan DF, Mieler WF, Hariprasad SM. Spectral-domain optical coherence tomography: a comparison of modern high-resolution retinal imaging systems[J]. Am J Ophthalmol, 2010, 149(1): 18-31. DOI: 10.1016/j.ajo.2009.08.037.
7. Liu P, Sun Y, Dong C, et al. A new method to predict anatomical outcome after idiopathic macular hole surgery[J]. Graefe’s Arch Clin Exp Ophthalmol, 2016, 254(4): 683-688. DOI: 10.1007/s00417-015-3116-x.
8. Armitage P, Colton T. Receiver operating characteristics (ROC) curves[M]//Armitage P, Colton T. Encyclopedia of biostatistics. New York: John, 1998: 3737-3744.
9. 余松林. 诊断试验的评价[M]//余松林.医学统计学[M].北京: 人民卫生出版社, 2002: 164-178.Yu SL. Evaluation of diagnostic test[M]//Yu SL. Medical statistics. Beijing: People’s Medical Publishing House, 2002: 164-178.
10. Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests[J]. Prev Vet Med, 2000, 45(1-2): 23-41.
11. Hajian-Tilaki K. Receiver operating characteristic (ROC) curve an alysis for medical diagnostic test evaluation[J].Caspian J Intern Med, 2013, 4(2): 627-635.
12. Ip MS, Baker BJ, Duker JS, et al. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography[J]. Arch Ophthalmol, 2002, 120(1): 29-35.
13. Hejsek L, Dusova J, Stepanov A, et al. Re-operation of idiopathic macular hole after failed initial surgery[J]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2014, 158(4): 596-599. DOI: 10.5507/bp.2013.088.
14. Jaycock PD, Bunce C, Xing W et al. Outcomes of macular hole surgery: implications for surgical management and clinical governance[J]. Eye (Lond), 2005, 19(8): 879-884. DOI: 10.1038/sj.eye.6701679.
15. Goker YS, Koc M, Yuksel K, et al. Relationship between peeled internal limiting membrane area and anatomic outcomes following macular hole surgery: a quantitative analysis[J/OL]. J Ophthalmol, 2016, 2016: 5641273[2016-06-16]. https://dx.doi.org/10.1155/2016/5641273. DOI: 10.1155/2016/5641273.
16. Raymond I, Kapoor KG. No face-down positioning and broad internal limiting membrane peeling in the surgical repair of idiopathic macular holes[J]. Ophthalmology, 2013, 120(10): 1998-2003. DOI: 10.1016/j.ophtha.2013.06.001.
17. Carnevali A, Cicinelli MV, Capuano V, et al. Extent of internal limiting membrane peeling and its impact on macular hole surgery outcomes: a randomized trial[J]. Am J Ophthalmol, 2016, 169: 179-188. DOI: 10.1016/j.ajo.2016.06.041.
18. Haritoglou C, Gass CA, Schaumberger M, et al. Macular changes after peeling of the internal limiting membrane in macular hole surgery[J]. Am J Ophthalmol, 2001, 132(3): 363-368.
19. Modi A, Giridhar A, Gopalakrishnan M. Comparative analysis of outcomes with variable diameter internal limiting membrane peeling in surgery for idiopathic macular hole repair[J]. Retina, 2017, 37(2): 265-273. DOI: 10.1097/IAE.0000000000001123.

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Comparison of different measure methods of macular hole closure index for predicting the anatomical prognosis of idiopathic macular hole surgery

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