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Elisa Carini, Ferdinando Bottoni, Emma Zanzottera, Marco Pellegrini, Mario Cigada, Giovanni Staurenghi; Macular Pigment After Surgery For Idiopathic Macular Hole. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3379.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose of the study was to investigate the changes of macular pigment after surgical repair of idiopathic macular hole (IMH).
Seven eyes of 7 consecutive patients affected by IMH (stage 3 and 4) were treated with 25 gauge pars plana vitrectomy, Brilliant Blue assisted peeling of internal limiting membrane, air/fluid exchange with subsequent injection of 20% sulfur hexafluoride and strict face-down positioning for 3 to 5 days. Follow-up examinations were scheduled at 1, 3, 6 and 9 months after the operation and they included the following examinations: best corrected visual acuity (BCVA, Snellen charts), SD OCT ( Heidelberg HRA Spectralis), fundus autofluorescence (FA, HRA Spectralis) and measurement of macular pigment optical density (MPOD) with 2 wavelength autofluorescence ( HRA Heidelberg).
Mean age was 68,7 years. All IMHs closed after surgery . Mean BCVA changed from 0.2 before surgery to 0,7 after surgery. The mean follow up was 6.4 months (range, 1 to 9 months).MPOD was already detectable at first month follow-up visit in all the patients and none of them experienced progressive gain in MPOD during the follow up period.There was no apparent correlation between external limiting membrane (ELM) recovery and MPOD: eyes with still disrupted ELM at 1 month (4 out of 7) showed levels of MPOD which were comparable to those at final follow-up visit.A more consistent lack of correlation was observed between recovery of the inner segment/outer segment (IS/OS) line and MPOD: none of the seven eyes showed a continuous IS/OS line at one month whereas MPOD was already detectable in all patients at the same time point.The presence of a continuous IS/OS line was the most important predictive factor for BCVA (p<0,0001).MPOD had also a positive correlation with BCVA (p=0,02).
Macular pigment seems to be detectable in the immediate post operative period after surgical repair of IMH. This might support the assumption that the macular pigment detected after surgery is the one already present at the edges of the hole before surgery. More patients are needed to better understand the clinical and eventually the predictive value of MPOD.
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