RETINAL DISORDERS Assessment of OCT measurements as prognostic factors in myopic macular hole surgery without foveoschisis Micol Alkabes & Leyla Padilla & Cecilia Salinas & Paolo Nucci & Lucia Vitale & Francesco Pichi & Anniken Burès-Jelstrup & Carlos Mateo Received: 26 October 2012 / Revised: 2 April 2013 / Accepted: 8 April 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Background To assess the role of Spectral Domain Optical Coherence Tomography (SD-OCT) measurements as prog- nostic factors in myopic macular hole (MMH) surgery. Methods In a retrospective cohort study, we evaluated 42 eyes of 42 patients (Spherical equivalent > -6.00 D) who underwent pars plana vitrectomy with internal limiting mem- brane peeling for MMH without foveoschisis. Statistical anal- ysis was performed to correlate postoperative best corrected visual acuity (BCVA) with preoperative BCVA, age, degree of myopia and seven preoperative OCT measurements: macular hole (MH) base, MH minimum diameter, MH height, Hole Form Factor (HFF), Macular Hole Index (MHI), Diameter Hole Index (DHI) and Tractional Hole Index (THI). Results Primary and final anatomical success rate were 83.3 % (35/42) and 90.5 % (38/42), respectively. Four patients deferred reoperation and three underwent a second surgical approach to achieve MH closure. A posterior staphyloma was observed in 27 of 42 patients, and in three of them the MH was located in the apex of the staphyloma. Two of these three cases showed an open MH after the first surgery. Postoperative visual acuity improved in 22/42 (52.4 %) patients, worsened in 7/42 (16.7 %) and remained unchanged in 13/42 (30.9 %). Only MH minimum diameter (P=0.03) and HFF (P=0.02) correlated significantly with postoperative BCVA. Conclusions Minimum diameter and HFF are strongly cor- related with postoperative visual outcomes in cases of MMH. Since analyzing MH configuration seems to improve the anatomical success rate after vitreous surgery in highly myopic patients, these parameters should be preoperatively evaluated by SD-OCT. Keywords High myopia . Myopic macular hole . Posterior staphyloma . Optical coherence tomography . Vitreoretinal surgery Introduction Macular hole (MH) was first described by Knapp in 1869 in a patient who sustained an ocular blunt trauma [1]. However, it has increasingly being recognized that this condition is more frequently idiopathic, although it can be also considered a common complication in highly myopic eyes. Due to an excessive axial elongation [2–4] , these patients can develop posterior ectasia of the globe known as posterior staphyloma (PS) [5], which can be associated with a full thickness MH with or without foveoschisis and retinal detachment (RD) in some cases [6–8]. Several surgical procedures are available for MH repair with or without RD in high myopia, including pars plana vitrectomy (PPV) with gas or silicone oil tamponade, macular buckling (MB), and scleral shortening technique [9–12]. Moreover, although spontaneous closure of a recurrent myopic macular hole (MMH) can occur [13], some patients require multiple interventions to achieve MH closure [14–16]. However, due to some degree of posterior chorioretinal atrophy, which causes a lack of contrast between the MH and Presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO), Fort Lauderdale, Florida, May 2011 M. Alkabes IMO—Instituto de Microcirugía Ocular, c/ Josep Maria Llado, 3, Barcelona, Spain L. Padilla : C. Salinas : A. Burès-Jelstrup : C. Mateo IMO—Instituto de Microcirugía Ocular, Barcelona, Spain M. Alkabes : P. Nucci : L. Vitale : F. Pichi Clinica Oculistica—Ospedale San Giuseppe, Università di Milano, Milan, Italy M. Alkabes (*) University Eye Clinic, San Giuseppe Hospital, Via San Vittore, 12, 20123 Milan, Italy e-mail: micol_alkabes@hotmail.com Graefes Arch Clin Exp Ophthalmol DOI 10.1007/s00417-013-2347-y