Intraretinal Cysts in Macular Hole: A Structure-Function Correlation Based on En Face Imaging

Figures & data

Figure 1 (A) Demonstrates automated segmentation showing two types of the cyst (inner nuclear layer [INL] and outer plexiform layer [OPL] in the en face optical coherence imaging (OCT) scan). (B) Shows manual segmentation with an en face scan of the INL, small multiple circular cysts occupying a larger area on the en face. (C) shows manual segmentation with an en face scan of the OPL, note larger, radially oriented cyst occupying a smaller area around the macular hole in comparison to the INL.

Figure 2 (A) Cross-sectional spectral-domain optical coherence imaging (SD-OCT) image showing preoperative ellipsoid zone (EZ; yellow line) and external limiting membrane (ELM; green line) defect measurements. (B) Cross-sectional SD-OCT image showing postoperative EZ and ELM defect measurements. (C) Preoperative en face OCT scan showing measurement of minimum inlet diameter of macular hole (yellow). (D) Preoperative en face OCT scan showing measurement of the base diameter of macular hole (yellow).

Table 1 Difference Between the Preoperative Variables in the Two Groups

Preoperative Variables			Group 1	Group 2	P-value
Age		Mean ± SD	69.29 ± 5.28	69.79 ± 4.4	0.788
Gender	Males	Number (Percentage)	8 (57.1)	4 (28.6)	0.252
	Females		6 (42.9)	10 (71.4)
Duration of symptoms		Median (IQR)	12 (3–34)	16 (4–50)	0.564
ETDRS Letter			61.14 (40.5–611.1)	46.09 (5.6–50.5)	0.022*
ELM Defect (µm)			511 ± 215.39	718.64 ± 211.05	0.016*
EZ Defect (µm)		Mean ± SD	890.21 ± 485.97	1112.36 ± 313.93	0.163
Basal Diameter of MH			8769 (3626–18399)	20355 (10129–32205.5)	0.024*
Minimum Inlet area of MH		Median (IQR)	2469 (1130–4490.5)	6257 (5711.5–7373.5)	0.019*
IPL cyst Area			48361 (23150–187429.5)	144922 (72175.5–320171.5)	0.027*
IPL cyst %			25.94 (17.48–41.49)	19.93 (14.91–29.43)	0.232
OPL cyst Area			35451 (25597.5–69408.5)	70018 (50179–107516)	0.031*
OPL cyst %		Mean ± SD	57.39 ± 9.97	51.05 ± 14.03	0.18

Note: *Statistically significant.

Abbreviations: SD, standard deviation; IQR, interquartile range; ETDRS, early treatment of diabetic retinopathy study; ELM, external limiting membrane; EZ, ellipsoid zone; MH, macular hole; IPL, inner plexiform layer; OPL, outer plexiform layer.

Table 2 Difference Between the Postoperative Variables in the Two Groups

Postoperative Variables		Group 1	Group 2	P-value
ETDRS Letter Score	Mean ± SD	74.78 ± 5.27	47.39 ± 19.35	<0.001*
Gain in ETDRS Letter Score	Median (IQR)	15.05 (15.05–32.52)	11.09 (0–44.45)	0.143
ELM Defect (µm)		0 (0–431.5)	533 (91.5–783.5)	0.045*
EZ Defect (µm)		142 (53.5–558.5)	775 (280.5–883)	0.017*

Note: *Statistically significant.

Abbreviations: ETDRS, early treatment of diabetic retinopathy study; SD, standard deviation; IQR, interquartile range; ELM, external limiting membrane; EZ, ellipsoid zone.

Table 3 Difference Between the Area of Cyst Involvement Within the Retinal Layers in the Study Eyes

	Median IPL Area	Interquartile Range	Median OPL Area	Interquartile Range	P-value
28 eyes	85334.5	[6204–490,283]	54848.5	[17,468–242,247]	0.049*
Group 1	56133.5	[6204–286,435]	39965.5	[17,468–166,275]	0.62
Group 2	146083	[50,279–490,283]	68731.5	[28,017–242,247]	0.03*

Note: *Statistically significant.

Abbreviations: IPL, inner plexiform layer; OPL, outer plexiform layer.

Table 4 Difference Between the Percentage of Cysts Involvement Within the Retinal Layers in the Study Eyes

	Median % of Cyst in IPL	Interquartile Range	Median % of Cyst in OPL	Interquartile Range	P value
28 eyes	23.104	[6.776–67.5]	56.1455	[29.28–72.19]	< 0.00001*
Group 1	26.495	[9.88–67.5]	57.4805	[40.13–72.19]	0.0002*
Group 2	20.905	[6.776–47.69]	47.59	[29.28–68.737]	< 0.0001*

Note: *Statistically significant.

Abbreviations: IPL, inner plexiform layer; OPL, outer plexiform layer.

Figure 3 Group 1; (A) Binarized en face scan of the outer plexiform layer (OPL), with an outer yellow outline of the area of the cyst and inner yellow outline of the area of macular hole. The area between the two yellow outlines denotes the area of OPL cysts (B) Binarized en face scan of the inner nuclear layer (INL), with an outer yellow outline of the area of the cyst and inner yellow outline of the area of macular hole. The area between the two yellow outlines denotes the area of the OPL cyst. (C) Binarized en face scan of the base diameter, with the area marked in yellow. Note the positive correlation in the INL and OPL area and between the basal diameter and OPL/INL cyst area. (Figures 2 and 3) (D) Binarized en face scan of the minimum inlet diameter of the hole, with the area marked in yellow. (E) Cross-sectional spectral-domain optical coherence imaging (SD-OCT) showing preoperative ellipsoid zone (EZ) and external limiting membrane (ELM) loss. (F) Cross-sectional SD-OCT image showing the postoperative ELM and EZ loss.

Figure 4 Group 2; (A) Binarized en face scan of the outer plexiform layer (OPL), with an outer yellow outline of the area of the cyst and inner yellow outline of the area of macular hole. The area between the two yellow outlines denotes the area of OPL cysts (B) Binarized en face scan of the inner nuclear layer (INL), with an outer yellow outline of the area of the cyst and inner yellow outline of the area of macular hole. The area between the two yellow outlines denotes the area of the OPL cyst. (C) Binarized en face scan of the base diameter, with the area marked in yellow. (D) Binarized en face scan of the minimum inlet diameter of the hole, with the area marked in yellow. (E) Cross-sectional spectral-domain optical coherence imaging (SD-OCT) showing preoperative ellipsoid zone (EZ) and external limiting membrane (ELM) loss. (F) Cross-sectional SD-OCT image showing the postoperative ELM and EZ loss.

Table 5 Correlation of Intraretinal Cysts with Other Parameters in the Study Eyes

	Total Population (28 Eyes)		Group 1		Group 2
Correlation	Correlation Coefficient	P-value	Correlation Coefficient	P-value	Correlation Coefficient	P-value
OPL cyst area vs Duration of Symptoms	0.264	0.175	0.3	0.297	0.193	0.509
IPL cyst area vs Duration of Symptoms	0.29	0.135	0.181	0.536	0.368	0.196
OPL cyst % vs Duration of Symptoms	−0.023	0.907	0.256	0.377	−0.146	0.618
IPL cyst % vs Duration of Symptoms	−0.058	0.769	−0.035	0.905	−0.007	0.982
IPL cyst area vs OPL cyst area	0.768	<0.001*	0.679	0.008*	0.771	0.001*
IPL cyst % vs OPL cyst %	0.246	0.206	0.292	0.311	0.174	0.553
OPL cyst area vs Basal Diameter	0.841	<0.001*	0.802	0.001*	0.829	<0.001*
IPL cyst area vs Basal Diameter	0.718	<0.001*	0.609	0.021*	0.644	0.013*
OPL cyst area vs Minimal Inlet	0.693	<0.001*	0.675	0.008*	0.648	0.012*
IPL cyst area vs Minimal Inlet	0.693	<0.001*	0.798	0.001*	0.464	0.095
OPL cyst % vs Basal Diameter	−0.223	0.253	−0.165	0.573	−0.143	0.626
IPL cyst % vs Basal Diameter	−0.127	0.52	−0.152	0.605	0.116	0.692
OPL cyst % vs Min Inlet	−0.448	0.017*	−0.371	0.191	−0.143	0.626
IPL cyst % vs Min Inlet	−0.268	0.168	−0.42	0.135	0.644	0.013*

Note: *Statistically significant.

Abbreviations: OPL, outer plexiform layer; IPL, inner plexiform layer.