QUANTITATIVE-ANALYSIS OF MACULAR HOLES WITH SCANNING LASER TOMOGRAPHY

Objective: The purpose of the study is to establish objective, quantit ative, and reproducible three-dimensional analysis for macular holes w ith scanning laser tomography and to correlate measurements with visua l acuity. Design: The authors performed a cross-sectional, nonrandomiz ed study. Participants: The authors examined 28 full-thickness macular holes of 23 patients aged 61 to 84 years. Intervention: Confocal infr ared imaging with scanning laser tomography using the TopSS (790 nm, 1 0 degrees field) three-dimensional measurements and macular hole analy sis were performed. Main Outcome Measures: Area, depth, and volume par ameters for both macular holes and rims were obtained in two ways: (I) reference plane for analysis equal to height of the retina (offset su rface distance [OSD] 0) or (2) equal to height-of the surrounding edem atous rim of the hole (OSD user). Correlation of measurements with vis ual acuity and groups of macular holes was performed. Reproducibility from three image series per subject and intraobserver variability from ten measurements in four subjects were computed. Results: Scanning la ser tomography could detect macular hole and rim features in all subje cts. Infrared images provided clinically useful information that may h elp explain macular hole pathophysiology, Based on quantitative, three -dimensional measurements, holes were assigned to four groups: large, small, shallow, and average, Groups varied significantly (P < 0.05) fo r tile majority of measurements. Visual acuity correlated significantl y (P < 0.05) with macular hole volume, depth, slope, and rim height wi th OSD user only, but not with hole area. Holes computed with OSD user were deeper and of greater volume. Reproducibility was excellent for hole area, slope, and rim area; good for hole volume and depth; variab le for rim volume; and improved with OSD user. Intraobserver variabili ty was low in each group. Conclusions: Scanning laser tomography is a reproducible three-dimensional imaging technique providing objective a nd quantitative clinical information in assessing, grouping, and manag ing macular holes. By setting the OSD to rim height, additional inform ation of rim height and hole volume was provided and correlated with v isual acuity. In addition, more reliable differences among macular hol e groups were found. Axial measurements such as macular hole depth, vo lume, and rim height may be more important for visual acuity than hole area indicating their possible predictive value for outcome measures.