This retrospective research study aimed to investigate the evolution of glial proliferation of varying grades after successful idiopathic macular hole repair and its effects on foveal microstructure and best-corrected visual acuity (BCVA). Two-hundred and two eyes were enrolled in this study (right: 98 eyes; left: 104 eyes) from 196 patients (48 males and 148 females) with a mean age of 64.6 ±5.5 years (range: 49-85 years). The mean preoperative minimum linear diameter (MLD) was 510.0 ±152.3μm (range: 162-882μm). Based on optical coherence tomography images, glial proliferation was classified into three types: A-type, which replaced the entire intraretinal layer; B-type located at the level of and above the external limiting membrane (ELM); and C-type, situated above the ELM. Of sixty-seven eyes that attended for the 1-, 4-, and 10-month follow-up, A-type, B-type, C-type, and no glial proliferation were identified in 27 (40.3%), 17 (25.4%), 20 (29.8%), and three eyes (4.5%), respectively at one month. Within 10 months, the prevalence of A-type glial proliferation significantly decreased (p=<0.001), and the changes in B-type (p=0.261), C-type (p=0.151), and no glial proliferation (p=0.492) were not significant. In 32 of the 67 eyes, the grade of glial proliferation gradually improved, with A-type transforming into B- or C-type in 19 of 27 eyes (70.4%), B-type into C-type or no glial proliferation in 11 out of 17 eyes (64.7%) and C-type gradually disappearing in two out of 20 eyes (10.0%). However, 30 eyes (44.8%) maintained the same grade of glial proliferation throughout the 10-month follow-up. Among the eyes that attended at least one follow-up (one month, 202 eyes; four months, 161 eyes; 10 months, 97 eyes), those with A-type glial proliferation showed the most defective outer retinal layers, worst BCVA, and thinnest central fovea compared with the other two types at all follow-up time points (p=<0.001). Eyes with C-type glial proliferation showed significantly better photoreceptor layer status and BCVA compared with those with B-type glial proliferation. The receiver operating characteristic (ROC) analysis indicated that A-type glial proliferation at one month, showed significant association with BCVA at 10 months, that could be accurately predicted by the minimum linear diameter with a cut-off >547.5μm (p<0.001). The study concluded that A-type glial proliferation substantially resolves within 10 months but the prevalence of B- and C-type remains unchanged. B-type glial proliferation hinders the restoration of photoreceptors and impairs visual recovery despite being located within the inner retina. Limitations: retrospective nature of the study. The ethnic variation being an independent factor associated with surgical prognosis, may not be reproducible in other ethnicities. A 10-month follow-up period may have been insufficient to fully observe the evolution of glial cell proliferation.
The evolution and visual prognosis of glial proliferation with different grades after macular hole surgery: an optical coherence tomography-based study.
Qi B, Yu Y, Yang X, Zhang K, et al.
OPHTHALMOLOGICA
2023;246:314-23.
