4.6 Article

External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

Journal

EYE
Volume 26, Issue 1, Pages 61-69

Publisher

NATURE PUBLISHING GROUP
DOI: 10.1038/eye.2011.237

Keywords

external limiting membrane; macular hole repair; spectral domain OCT

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Funding

  1. Bendheim-Lowenstein Retinal Fund
  2. Gladys Brookes Foundation

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Purpose To investigate the relationship between postoperative visual acuity and integrity of the external limiting membrane (ELM) and inner segment outer segment (IS OS) junction layers, using spectral domain optical coherence tomography (SD-OCT), in eyes with macular holes (MHs) following surgical repair. Methods Medical charts of MH-operated cases were retrospectively identified and reviewed. The primary outcome measures were best-corrected visual acuity (BCVA) and the status of the ELM and IS OS lines, using SD-OCT. at 6 weeks and 6 months postoperatively. Results Sixty-two eyes of 62 patients were included. At 6 weeks following surgery, out of 56 (90.3%) eyes with successful MH closure: 0 eyes showed the combination of disrupted ELM and continuous IS OS layers; 7 eyes (12.5%) demonstrated continuity of both ELM and IS-OS (ELMc/IS-OSc group); 29 eyes (51.8%) had continuous ELM with discontinuous IS-OS layers (ELMc/IS-OSd group); and 20 eyes (35.7%) had discontinuities in both the layers (ELMd/IS-OSd group). The ELMd/IS-OSd group had the lowest visual gain at 6 months (P = 0.03). At 6 months, a restoration of the integrity of IS-OS layer was observed in 51.7% eyes in the ELMc/IS-OSd group and in 5% in the ELMd/IS-OSd group (P = 0.001). Conclusions When both ELM and IS-OS layers showed disruptions 6 weeks postoperatively, a significantly worse BCVA was measured at 6 months, compared with the eyes with only IS-OS disruptions, detected 6 weeks following surgery. The integrity of the ELM layer appears to be a critical factor for the restoration of the photoreceptor layer and for predicting a successful visual outcome following MH repair. Eye (2012) 26, 61-69; doi:10.1038/eye.2011.237; published online 7 October 2011

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