Comparison of the Photoreceptor Mosaic Before and After Macular Hole Surgery With High-Resolution Adaptive Optics Imaging

IF 4.1 1区医学 Q1 OPHTHALMOLOGY American Journal of Ophthalmology Pub Date : 2024-10-23 DOI:10.1016/j.ajo.2024.10.018

Paola L. Oquendo , Thomas Wright , Sumana C. Naidu , Miguel Cruz Pimentel , Hesham Hamli , Mariam Issa , Afira Faleel , Flavia Nagel , Peng Yan , Rajeev H. Muni

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Abstract

Purpose

To assess the photoreceptor mosaic in patients with idiopathic full-thickness macular hole (MH) before and after pars plana vitrectomy (PPV) with adaptive optics enhanced retinal imaging (AO).

Design

Prospective case series.

Methods

Prospective cohort study of patients who presented at the Kensington Eye Institute, Toronto, Canada with a diagnosis of MH treated with PPV. Exclusion criteria: secondary MH, high myopia (axial length >26.5 mm), media opacity precluding optical coherence tomography or AO imaging, previous intraocular surgery except for cataract extraction. Imaging using an AO fundus camera (Imagine Eyes, RTX1) was performed preoperatively and 3 months following successful MH repair in both eyes. Cone density (CD), regularity, dispersion, and spacing were measured at 2° and/or 4° of eccentricity in 4 quadrants (superior, inferior, nasal, and temporal) with pre- and postoperative values compared.

Results

We included 18 eyes of 9 patients. At 2° there was significant reduction in CD and increase in spacing and dispersion and a nonsignificant change in regularity postoperatively. Comparison between preoperative and postoperative measurements at 2° mean (standard error) were: CD: 14,612 ± 3003 and 12,280 ± 4632 photoreceptors/mm² (95% CIs = –2413 to –702) P = .0004, regularity: 88% ± 7% and 84% ± 12% (95% CIs = –4.67 to 0.04) P = .054, dispersion: 19% ± 6% and 23% ± 10% (95% CIs = 0.5-4.24) P = .013, spacing: 9 ± 1 microns and 10 ± 2 microns (95% CIs = 0.40-1.27) P = .0002; at 4° was: CD: 13,377 ± 4339 and 12,770 ± 4391 photoreceptors/mm² (95% CIs = –1368 to 252) P = .176, regularity:87% ± 9% and 86% ± 12% (95% CIs = –4.65 to 0.08) P = .74, dispersion: 20% ± 8% and 20% ±9% (95% CIs = –2.11 to 1.5) P = .74, spacing:10 ± 2 microns and 10 ± 3 microns (95% CIs = –0.23 to 0.58) P = .39.

Conclusions

AO imaging allows quantitative assessment of the photoreceptor mosaic pre- and post-PPV in patients with MH. There was a significant change to the photoreceptor mosaic related to the MH at 2° pre- and postoperatively. AO imaging enables high-resolution investigation of the photoreceptor remodeling process following surgery, which may allow for a more thorough assessment of surgical outcomes.

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利用高分辨率自适应光学成像比较黄斑孔手术前后的感光器镶嵌图。

目的：通过自适应光学增强视网膜成像（AO）评估特发性全厚黄斑孔（MH）患者在平面玻璃体旁切除术（PPV）前后的感光器镶嵌情况：前瞻性病例系列研究：排除标准：继发性MH、高度近视（轴向长度大于26.5毫米）、介质混浊导致无法进行OCT或AO成像、曾进行过眼内手术（白内障摘除术除外）。术前和双眼成功修复 MH 后 3 个月，使用 AO 眼底照相机（Imagine Eyes, RTX1）进行成像。在 4 个象限（上、下、鼻、颞）偏心 2° 和 4° 处测量锥体密度 (CD)、规则性、分散性、规则性、分散性和间距，并比较术前和术后的数值：我们对 9 名患者的 18 只眼睛进行了测量。术后，2° 偏心率明显降低，间距和分散度明显增加，规则性变化不明显。术前和术后 2°测量值的平均值（标准误差= SE）比较如下：CD：14612 ± 3003 和 12280 ± 4632 光感受器/mm2 [95%CIs= -2413 to -702] p=0.0004；规则性：88 ± 7% 和 84 ± 12% [95%CIs= -4.67 to 0.04] p=0.054；分散性：19 ± 6% 和 23 ± 10% [95%CIs= 0.5 to 4.24] p=0.013；间距：9 ± 1 微米和 10 ± 2 微米 [95%CIs= 0.40 至 1.27] p=0.0002；在 4° 时为：CD：13377 ± 4339 和 12770 ± 4391 个光感受器/mm2 [95%CIs= -1368 to 252] p=0.176，规则性：87 ± 9% 和 86 ± 12% [95%CIs= -4.65 to 0.08] p=0.74，分散性：20 ± 8% [95%CIs= 0.40 to 1.27] p=0.0002；在 4° 时，CD：13377 ± 4339 和 12770 ± 4391 个光感受器/mm2 [95%CIs= -1368 to 252] p=0.176。74，色散：20 ± 8% 和 20 ±9 % [95%CIs= -2.11 to 1.5] p=0.74，间距：10 ± 2 微米和 10 ± 3 微米 [95%CIs= -0.23 to 0.58] p=0.39.结论：自适应光学成像可对MH患者PPV前后的光感受器镶嵌进行定量评估。术前和术后 2° 处的光感受器镶嵌与 MH 相关，变化明显。AO 成像可对手术后的光感受器重塑过程进行高分辨率研究，从而更全面地评估手术效果。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.