The evolution and visual prognosis of glial proliferation of different grades after macular hole surgery
Reviewed by Sofia Rokerya

This retrospective research study aimed to investigate the evolution of glial proliferation of varying grades after successful idiopathic macular hole repair and its effects on foveal microstructure and best-corrected visual acuity (BCVA). Two-hundred and two eyes were enrolled in this study (right: 98 eyes; left: 104 eyes) from 196 patients (48 males and 148 females) with a mean age of 64.6 ±5.5 years (range: 49–85 years). The mean preoperative minimum linear diameter (MLD) was 510.0 ±152.3μm (range: 162–882μm). Based on optical coherence tomography images, glial proliferation was classified into three types: A-type, which replaced the entire intraretinal layer; B-type located at the level of and above the external limiting membrane (ELM); and C-type, situated above the ELM. Of sixty-seven eyes that attended for the 1-, 4-, and 10-month follow-up, A-type, B-type, C-type, and no glial proliferation were identified in 27 (40.3%), 17 (25.4%), 20 (29.8%), and three eyes (4.5%), respectively at one month. Within 10 months, the prevalence of A-type glial proliferation significantly decreased (p=<0.001), and the changes in B-type (p=0.261), C-type (p=0.151), and no glial proliferation (p=0.492) were not significant. In 32 of the 67 eyes, the grade of glial proliferation gradually improved, with A-type transforming into B- or C-type in 19 of 27 eyes (70.4%), B-type into C-type or no glial proliferation in 11 out of 17 eyes (64.7%) and C-type gradually disappearing in two out of 20 eyes (10.0%). However, 30 eyes (44.8%) maintained the same grade of glial proliferation throughout the 10-month follow-up. Among the eyes that attended at least one follow-up (one month, 202 eyes; four months, 161 eyes; 10 months, 97 eyes), those with A-type glial proliferation showed the most defective outer retinal layers, worst BCVA, and thinnest central fovea compared with the other two types at all follow-up time points (p=<0.001). Eyes with C-type glial proliferation showed significantly better photoreceptor layer status and BCVA compared with those with B-type glial proliferation. The receiver operating characteristic (ROC) analysis indicated that A-type glial proliferation at one month, showed significant association with BCVA at 10 months, that could be accurately predicted by the minimum linear diameter with a cut-off >547.5μm (p<0.001). The study concluded that A-type glial proliferation substantially resolves within 10 months but the prevalence of B- and C-type remains unchanged. B-type glial proliferation hinders the restoration of photoreceptors and impairs visual recovery despite being located within the inner retina. Limitations: retrospective nature of the study. The ethnic variation being an independent factor associated with surgical prognosis, may not be reproducible in other ethnicities. A 10-month follow-up period may have been insufficient to fully observe the evolution of glial cell proliferation.

The evolution and visual prognosis of glial proliferation with different grades after macular hole surgery: an optical coherence tomography-based study.
Qi B, Yu Y, Yang X, Zhang K, et al.
OPHTHALMOLOGICA
2023;246:314–23.