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A.J. Witkin, T.H. Ko, J.G. Fujimoto, A. Chan, W. Drexler, A.H. Rogers, C.R. Baumal, E. Reichel, J.S. Schuman, J.S. Duker; Ultrahigh Resolution OCT Imaging of Microstructural Abnormalities in Surgically Closed Macular Holes . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1538.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate retinal anatomy with ultrahigh resolution optical coherence tomography (UHR–OCT) following anatomically successful repair of macular holes. Methods: Twenty eyes were clinically diagnosed with macular hole, and subsequently underwent surgical repair. Following surgery, visual acuity was measured, and both biomicroscopic examination and StratusOCT imaging confirmed a flat/closed macular anatomy. In addition to StratusOCT (10µm axial resolution), an UHR–OCT retinal imaging system capable of ∼3 µm axial resolution was used to evaluate retinal anatomy following macular hole repair. Results: All patients had macular morphologic abnormalities visible on UHR–OCT. The morphologic abnormalities were separated into four categories: photoreceptor defects, small subfoveal retinal detachments, moderately–reflective foveal lesions, and epiretinal membranes. Photoreceptor defects were seen in all 20 patients (100%). Two patients (10%) had hyporeflective areas under the foveal photoreceptors, representing small retinal detachments. Moderately–reflective foveal lesions were seen in 11 out of 20 patients (55%). In two patients, this lesion was quite large and replaced normal foveal anatomy. Epiretinal membranes were seen in 13 out of 20 patients (65%). Conclusions: UHR–OCT provides highly detailed images of retinal anatomy with an unprecedented ability to visualize fine anatomical features such as epiretinal membranes and photoreceptor morphology. In patients following macular hole repair, all UHR–OCT images show photoreceptor abnormalities, which can explain the persistently decreased visual acuity present in all patients. Small pockets of subfoveal retinal fluid, seen in two patients, likely affect visual acuity as well. An area of foveal hyperreflectivity visible in the majority of patients may represent a glial proliferative response at the site of macular hole reapproximation. Thin epiretinal membranes are apparent in the majority of these patients; these membranes are unlikely to decrease visual acuity and might play a role in reestablishing the normal foveal anatomy following surgery.
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