Optical coherence tomography as a key tool for assessing macular hole rigidity criteria

Macular hole (MH) is one of the most common pathologies of the vitreomacular interface. Despite significant advances in vitreoretinal surgery, there exists a subset of MHs that are refractory to standard approaches. Purpose. To assess morphometric parameters of the central area of the retina and identify criteria of MH rigidity using optical coherence tomography (OCT). Materials and Methods. The study included 27 patients (27 eyes). Patients were divided into two groups: Group I (n = 12) — chronic MHs (lasting more than 6 months), stage IV according to J.D. Gass, with the presence of an adhesion band between the retinal pigment epithelium (RPE) and neuroretina at the edges, as detected by OCT; Group II (n = 15) — recent MHs (from 2 weeks to 6 months), stage IV according to J.D. Gass. All patients underwent spectral-domain OCT using the RTVue device (Optovue, USA). Results. Patients in Group I demonstrated a specific macular zone profile: 1. an adhesion band between the RPE and neuroretina, reflected by the PPhAB length; 2. flat, square edges, indicated by MHE angle <90° (p<0.05), smaller differences between MHDmax and MHDmin (p<0.05), between MHE height (p<0.05), as well as between MHE height and M height compared to Group II (p<0.05); 3. often absence of cystoid edema in the neuroretina at the MH edges (p<0.05). Conclusion. Optical coherence tomography allows the assessment of several morphometric features that identify criteria of MH rigidity, contributing to the optimization of pathogenetically justified surgical strategies.