Foveal Microstructure and Visual Acuity in Surgically Closed Macular Holes: Spectral-Domain Optical Coherence Tomographic Analysis

Purpose: To evaluate reconstructive changes in foveal microstructures and identify a correlation with visual outcomes in eyes with surgically closed macular holes (MHs). Design: Retrospective, consecutive, observational case series. Participants: Forty eyes (40 patients) with surgically closed MHs. Methods: Spectral-domain optical coherence tomography (SD-OCT) was performed to assess the foveal microstructural changes 3 and 12 months postoperatively. The correlation between the postoperative best-corrected visual acuity (BCVA) and the integrity of the foveal photoreceptor layer was evaluated. Main Outcome Measures: The integrity of the back-reflection lines from the photoreceptor inner segment (IS) and outer segment (OS) junction and the external limiting membrane (ELM) on SD-OCT images and the BCVA measured on the same day. Results: The integrity of the foveal photoreceptor layer was the only postoperative SD-OCT finding significantly associated with the 3-month BCVA (r=0.483; P=0.002). The eyes were categorized into 3 groups according to restoration of the IS/OS junction and ELM signals: 6 eyes (15%) in group A with complete restoration of the IS/OS junction and the ELM; 26 eyes (65%) in group B with a disrupted IS/OS junction and intact ELM; and 8 eyes (20%) in group C with disruption or loss of the IS/OS junction and the ELM. Although the baseline BCVA did not differ significantly (P=0.137) among groups, the mean 3-month BCVA values in groups A and B, both with reconstructed ELM with or without a restored photoreceptor IS/OS, were significantly better than in group C (P<0.05); the difference between groups A and B was not significant (P>0.05). Groups A (P=0.029) and B (P<0.001) had significant visual improvement at 12 months; group C did not have marked visual recovery. Fourteen eyes (54%) in group B had subsequent realignment of the foveal photoreceptor IS/OS; no eyes in group C had a restored IS/OS at 12 months. The presence of the ELM at 3 months is a critical structural feature significantly correlated with the BCVA at 12 months (r=0.832, P<0.001). Conclusions: Reconstruction of the foveal ELM in the early postoperative period helps predict subsequent restoration of the foveal photoreceptor layer and the potential for better visual outcomes.