Original article
Foveal Microstructure on Spectral-Domain Optical Coherence Tomographic Images and Visual Function After Macular Hole Surgery

https://doi.org/10.1016/j.ajo.2011.02.001Get rights and content

Purpose

To determine the correlation between the recovery of foveal microstructure and the visual acuity or the foveal sensitivity after idiopathic macular hole (MH) closure.

Design

Prospective, consecutive, observational case series.

Methods

We studied 43 eyes of 43 patients before and 1, 3, and 6 months after MH surgery. The best-corrected visual acuity (BCVA), the foveal sensitivity measured by MP1 microperimetry, and the photoreceptor inner and outer segment (IS/OS) junction and the external limiting membrane (ELM) determined by spectral-domain optical coherence tomography were investigated.

Results

Preoperatively, the lengths of the IS/OS junction defect and the ELM defect were significantly correlated with only the foveal sensitivity (P < .0001). At all postoperative times, the lengths of both the IS/OS and ELM defects were significantly correlated with both the BCVA and the foveal sensitivity (P < .05 for all). The preoperative lengths of both the IS/OS and ELM defects were significantly correlated with the foveal sensitivity at 6 months after surgery (P = .0022, P = .0031, respectively). The IS/OS junction defect was significantly correlated with the ELM defect at all times (P < .0001 for all). No restoration of the IS/OS junction was observed in eyes without the ELM restoration.

Conclusions

The restoration of the ELM is closely associated with that of the IS/OS junction. The preoperative IS/OS or ELM defect was associated with the postoperative foveal sensitivity. The restoration of not only the IS/OS junction but also the ELM may reflect the morphologic and functional recovery of the foveal photoreceptors in surgically closed MHs.

Section snippets

Subjects and Methods

This prospective study was designed to examine patients with an idiopathic MH who were scheduled to undergo MH surgery. Forty-five patients who underwent pars plana vitrectomy for an MH at the Chiba University Hospital from April 1, 2009 to April 30, 2010 were studied. Cases with traumatic or secondary macular holes, myopic eyes with a refractive error of more than −8.00 diopters, and cases in which the MH was not closed after the primary surgery were excluded.

Two patients were lost to

Postoperative Changes of Visual Acuity, Foveal Sensitivity, and Foveal OCT Findings

The mean preoperative BCVA was 0.72 ± 0.31 logMAR units. The mean postoperative BCVA was 0.51 ± 0.34 logMAR units at 1 month, 0.36 ± 0.28 logMAR units at 3 months, and 0.26 ± 0.25 logMAR units at 6 months. At all postoperative times, the BCVA significantly improved as compared with the preoperative BCVA (P < .0001 for all). The mean preoperative foveal sensitivity was 8.28 ± 4.25 dB. The mean postoperative foveal sensitivity was 11.75 ± 3.37 dB at 1 month, 12.25 ± 3.64 dB at 3 months, and 13.31

Discussion

This study showed that the lengths of both the IS/OS junction defect and the ELM defect were significantly correlated with both the BCVA and the foveal sensitivity at all postoperative times. In addition, our results demonstrated that the length of the IS/OS junction defect was significantly correlated with the length of the ELM defect and that the restoration of the ELM was earlier than that of the IS/OS junction at all times and in all eyes. None of the eyes had a complete restoration of the

Emi Ooka, MD, PhD, graduated from Chiba University School of Medicine, Chiba, Japan, in 2004. She completed her residency at Chiba University Hospital and the Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine. Dr. Ooka's interest is on the treatment of macular diseases including macular hole, epiretinal membrane, and age-related macular degeneration.

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    Besides, this band may be gradually recovered after treatment in different conditions. For example, after surgery in macular hole (Ooka et al., 2011), in resolved central serous chorioretinopathy (Nakamura et al., 2016), and in RD (dell'Omo et al., 2015), a progressive recovery of the second band is found with time. As mitochondria are able to divide and generate new ones, they might explain the restoration of the second OCT band after treatment and, with it, the recovery of photoreceptors' health.

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Emi Ooka, MD, PhD, graduated from Chiba University School of Medicine, Chiba, Japan, in 2004. She completed her residency at Chiba University Hospital and the Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine. Dr. Ooka's interest is on the treatment of macular diseases including macular hole, epiretinal membrane, and age-related macular degeneration.

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