Change in macular perfusion after surgical treatment in patients with idiopathic macular hole: a retrospective cohort study

Abstract Objective To investigate prognostic predictive value of postoperative change in macular perfusion for idiopathic macular hole (IMH). Methods IMH patients who received posterior vitrectomy with internal limiting membrane peeling and gas tamponade were retrospectively included. Macular perfusion evaluated by vessel density and capillary perfusion density were collected from examination records of optical coherence tomography angiography (OCTA) performed before and after surgical treatment. Postoperative improvement in best-corrected visual acuity (BCVA) was studied as the outcome. Multivariable logistic regression was employed to investigate the association between change in macular perfusion and the outcome after adjusting for preoperative characteristics. Results Fifty-two eyes of 52 patients (71.2% female) were included into the analyses, with a mean age of 59.7 ± 6.6 years old and a mean basal macular hole diameter of 913.8 ± 250.4 µm. Vessel density increased from 17.3 ± 2.3 mm-1 to 18.1 ± 2.6 mm-1 one month after surgical treatment (P < 0.001), and capillary perfusion density increased from 36.8 ± 7.7% to 47.3 ± 11.1% (P < 0.001), together with an improvement in BCVA (logMAR from 1.2 ± 0.2 to 0.6 ± 0.4, P < 0.001). Results of univariable linear regress suggested poor preoperative BCVA and large macular hole size were associated with poor postoperative BCVA. After taking these variables into account, multivariable logistic regression suggested greater increase in capillary perfusion density was associated with better improvement in preoperative BCVA, but such an association was not observed in the change in vessel density. Conclusion Change in capillary perfusion density assessed with OCTA as a proxy for macular perfusion may be used as a prognostic predictor of IMH patients who received surgical treatment.