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Changes in choriocapillaris structure occurring in idiopathic macular hole before and after vitrectomy

  • Retinal Disorders
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Abstract

Purpose

The aim of this study was to analyze the anatomical choroidal vascular layers and the changes in idiopathic macular hole (IMH) eyes over time after vitrectomy.

Methods

This is a retrospective observational case–control study. Fifteen eyes from 15 patients who received vitrectomy for IMH and age-matched 15 eyes from 15 healthy controls were enrolled in this study. Retinal and choroidal structures were quantitatively analyzed before vitrectomy and 1 and 2 months after surgery using spectral domain-optical coherence tomography. Each choroidal vascular layer was divided into the choriocapillaris, Sattler’s layer, and Haller’s layer, and then, the choroidal area (CA), luminal area (LA), stromal area (SA), and central choroidal thickness (CCT) were calculated using binarization techniques. The ratio of LA to CA was defined as the L/C ratio.

Results

The CA, LA, and L/C ratios were 36.9 ± 6.2, 23.4 ± 5.0, and 63.1 ± 7.2 in the choriocapillaris of IMH and were 47.3 ± 6.6, 38.3 ± 5.6, and 80.9 ± 4.1 in that of control eyes, respectively. Those values were significantly lower in IMH eyes than in control eyes (each P < 0.01), whereas there was no significant difference in total choroid, Sattler’s layer, and Haller’s layer or CCT. The ellipsoid zone defect length showed a significant negative correlation with the L/C ratio in total choroid and with CA and LA in the choriocapillaris of IMH (R =  − 0.61, P < 0.05, R =  − 0.77, P < 0.01, and R =  − 0.71, P < 0.01, respectively). In the choriocapillaris, the LA were 23.4 ± 5.0, 27.7 ± 3.8, and 30.9 ± 4.4, and the L/C ratios were 63.1 ± 7.2, 74.3 ± 6.4, and 76.6 ± 5.4 at baseline, 1 month, and 2 months after vitrectomy, respectively. Those values showed a significant increase over time after surgery (each P < 0.05), whereas the other choroidal layers did not alter consistently with respect to changes in choroidal structure.

Conclusions

The current OCT-based study demonstrated that the choriocapillaris was exclusively disrupted between choroidal vascular structures in IMH, which may correlate with the ellipsoid zone defect. Furthermore, the L/C ratio of choriocapillaris recovered after IMH repair, suggesting an improved balance between supply and demand of oxygen that has collapsed due to temporary loss of central retinal function by IMH.

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Authors and Affiliations

  1. Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan

    Hiroaki Endo, Mitsuo Takahashi, Yuki Ito, Satoshi Katsuta & Manabu Kase

  2. Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, 060-8638, Japan

    Satoru Kase & Susumu Ishida

  3. Department of Ophthalmology, Kagoshima University, Kagoshima, Japan

    Shozo Sonoda, Tomonori Sakoguchi & Taiji Sakamoto

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  1. Hiroaki Endo
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  2. Satoru Kase
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Correspondence to Satoru Kase.

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Ethical approval

This study followed the principles of the Declaration of Helsinki. Institutional review board in Teine Keijinkai Hospital (IRB number: 2–021372-00) approved this study.

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This study involves human participants with retrospective, non-invasive observations.

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Endo, H., Kase, S., Takahashi, M. et al. Changes in choriocapillaris structure occurring in idiopathic macular hole before and after vitrectomy. Graefes Arch Clin Exp Ophthalmol 261, 1901–1912 (2023). https://doi.org/10.1007/s00417-023-06004-5

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