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1. OCT IN MACULAR
HOLES & ARMD
MADHUSUDAN DAVDA, MD,FMRF
MUMBAI EYE &RETINA CLINIC, CHEMBUR
A Super Speciality Retina Care Centre

2. The Normal OCT

4. When & Why do you need an OCT in
macular holes?
document & size a full thickness hole
prognosticate the hole - anatomical closure and
functional outcome
planning surgery & intraoperative OCT
timing of prone positioning

5. Sizing of holes
small <250 microns
medium 250-500 microns
large > 400 microns
ILM peel is not mandatory for holes upto 400 microns

6. Anatomy of a macular hole
minimum diameter
base diameter
height
arm length
macular hole inner opening
a
b
h
i

7. Macular hole indices
minimum diameter: a
height:b
base diameter: c
arm lengths: d,e
MHI = b/c
THI = b/a
DHI = a/c
HFF = d+e/c

8. Hole closure & Visual
outcome
min dia <311 mic
THI>1.41 (more the height, better is closure)
DHI < 0.5
HFF >0.9 (<0.5 poor closure rates)
Optical Coherence tomography predictive factors for macular hole
surgery outcome, Ruiz-Morena JM et al, Br J Ophthalmol. 2008

9. Types of hole closure
type 1 : closed hole without any defect of the foveal
neurosensory retina
type 2: persistent foveal defect of neurosensory
retina despite the whole rim of hole attached to the
underlying RPE with resolution of SRF and CME

10. visual outcome
Type 1 has better prognosis
intact IS-OS junction has better prognosis
Intact ELM has better prognosis
Increased photoreceptor outer segment thickness
(COST)
High THI values(>1.41) & low DHI values (<0.50)
have better visual prognosis

11. Type 1 closure
Intact ELM
BCVA 6/9 post surgery

12. Type 1 closure
Disrupted ELM, IS/OS & COST

13. Type 1 closure
Disrupted ELM, IS/OS & COST
BCVA 6/36 post surgery from <6/60

14. Type 1 closure
Reasonably intact ELM, IS/OS & COST
However note the RPE

16. Spontaneous Closure

17. take home..
OCT is not just to confirm presence of hole
smaller the size of hole better is the anatomical
closure
more the height better is the closure rate
look for the 4 outer lines for prognosis

18. OCT in Age Related Macular
Degeneration (ARMD)
Document presence/abscence of activity
Morphological variants
Prognosticate - visual, number of injections,
likelihood of alternative treatments
Follow up

19. OCT in Dry ARMD

20. OCT in Dry ARMD
confluent drusen
presence of pigment changes
wet ARMD in the other eye

21. OCT in Wet ARMD
identify morphological type
understand prognosis
decide additional investigations
line of management

22. components
RPE detachments
sub retinal space
intraretinal fluid

23. RPED & RPE rip

24. sub retinal space

25. PRE RPE (classic)
CNVM

26. Sub RPE (occult) CNVM

27. IPCV

28. oct criteria for PCV
multiple RPEDs
a sharp RPED peak
Notched RPED
Hyporeflective lumen of polyp adhered to hyper
reflective lesions beneath the RPE
hyper reflective intraretinal hard exudates

31. take home
multiple serosanguinous
PEDs
massive sub retinal
bleeds
presence of polyps
multiple PEDs
notched PED
presence of hypo lucent
polyps

32. RAP lesions

33. Retinal Angiomatosis
Proliferans (RAP lesions)
inner retinal cyst
outer retinal cyst
FVPED
SRF

34. Take Home..
patient with intra, sub retinal haemorrhage, hard
exudates and cme
right angled venue
usually require quite a few injections
develop extensive RPE atrophy post PDT

35. OCT & Treatment

36. special situations

37. RPE Rip

38. adult vitelliform dystrophy

39. “Thank you”
-team merc