Predictive value of ellipsoid zone-related angle parameters in primary surgery of large macular hole: a case control study

Background To explore the predictive value of Ellipsoid Zone (EZ) -related angle parameters for the outcome of primary macular hole surgery. Methods This was a retrospective study. Patients diagnosed with large macular hole (MH) (minimum diameter > 500 μm) between 2018 and 2021 were enrolled. All patients underwent 25-gauge pars plana vitrectomy, internal limiting membrane (ILM) peeling and air tamponade. Spectral-domain OCT (SD-OCT) and best corrected visual acuity (BCVA) were measured in preoperative and 2-week post-operative. Classic and angle related parameters were measured via ImageJ. Angle regularity (AR) were defined as the standard deviation of the angle parameters in vertical and horizontal direction. Results Seventy-six eyes were included for analysis; 24 eyes showed an unclosed macular hole at the 2-week postoperative and 52 eyes showed a closed hole. Preoperatively, MLD ( P < 0.001), BD ( P = 0.009) and diameter of EZ/ELM disruption ( P = 0.002 and 0.025) in patients failed to close the hole after primary surgery were significantly larger than those succeeded. EZ-MH ( P = 0.018), EZ-NFL ( P = 0.006), EZ-GCL ( P = 0.004), EZ-INL ( P = 0.002), EZ-OPL ( P = 0.009) and EZ-ONL ( P = 0.011) angles were smaller in patients with unclosed hole. AR of the EZ-NFL ( P = 0.009), EZ-GCL ( P = 0.009), EZ-OPL ( P = 0.023), EZ-ONL ( P = 0.048) and Basal-NFL ( P = 0.030) angles among the unclosed patients were significantly larger than those of the closed group. EZ-NFL ( P = 0.015), EZ-GCL ( P = 0.004), EZ-INL ( P < 0.001), EZ-OPL ( P < 0.001), EZ-ONL ( P < 0.001), Basal ( P = 0.023) and Basal-NFL ( P < 0.001) angles of hole-unclosed patients enlarged significantly after the surgery. Conclusions Patients with large macular holes and an increased EZ-related angle and angle AR are more likely to experience unsuccessful outcomes following primary MH surgery. Therefore, EZ-related angles hold potential as valuable parameters for predicting the surgical outcome.