Article Text
Abstract
Objective Full-thickness macular holes (MH) are classified principally by size, which is one of the strongest predictors of anatomical and visual success. Using a three-dimensional (3D) automated image processing algorithm, we analysed optical coherence tomography (OCT) images of 104 MH of patients, comparing MH dimensions and morphology with clinician-acquired two-dimensional measurements.
Methods and Analysis All patients underwent a high-density central horizontal scanning OCT protocol. Two independent clinicians measured the minimum linear diameter (MLD) and maximum base diameter. OCT images were also analysed using an automated 3D segmentation algorithm which produced key parameters including the respective maximum and minimum diameter of the minimum area (MA) of the MH, as well as volume and surface area.
Results Using the algorithm-derived values, MH were found to have significant asymmetry in all dimensions. The minima of the MA were typically approximately 90° to the horizontal, and differed from their maxima by 55 μm. The minima of the MA differed from the human-measured MLD by a mean of nearly 50 μm, with significant interobserver variability. The resultant differences led to reclassification using the International Vitreomacular Traction Study Group classification in a quarter of the patients (p=0.07).
Conclusion MH are complex shapes with significant asymmetry in all dimensions. We have shown how 3D automated analysis of MH describes their dimensions more accurately and repeatably than human assessment. This could be used in future studies investigating hole progression and outcome to help guide optimum treatments.
- macula
- imaging
- retina
- anatomy
- diagnostic tests/investigation
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Footnotes
YC and AVN contributed equally.
Contributors YC was involved in the conduct of the study, analysis of results, and writing and proof-reading the manuscript. AVN was involved in the conduct of the study, analysis of results, provision of materials and proof-reading the manuscript. IW was involved in the analysis of results. CG was involved in the provision of materials. MH was involved in the design of the study and provision of materials. BO was involved in the design of the study and proof-reading the manuscript. DHWS was involved in the design, conduct of the study, analysis of results, provision of materials, and writing and proof-reading the manuscript. DHWS is responsible for the overall content as guarantor.
Funding 'This work was supported by grant funding from the Wellcome trust small grant scheme (BH184036), The British and Eire Association of Vitreoretinal Surgeons, and the Indonesian Endowment Fund for Education, Indonesia (LPDP Indonesia), grant number 20150422012873 (sponsor for AVN)
Competing interests DHWS has acted as a consultant to Alcon, Orbit Biomedical and Oxurion, and has received research funding from Bayer and Alcon. BO is a chief technology officer (CTO) at Intogral.
Patient consent for publication Not required.
Ethics approval This research project adheres to the tenets of the Declaration of Helsinki. All data and scans were collected as part of routine care and fully anonymised, and as such under UK guidelines the investigation was categorised as service evaluation and did not require ethical approval.
Provenance and peer review Not commissioned; externally peer reviewed.