Assessing Photoreceptor Structure Following Macular Hole Closure

Abstract

 

Purpose

 

To assess foveal photoreceptor structure in eyes that have undergone vitrectomy surgery for closure of macular holes (MH) using spectral-domain optical coherence tomography (SD-OCT) and adaptive optics scanning light ophthalmoscopy (AOSLO).

 

Methods

 

In a prospective case series, 7 eyes of 7 patients were imaged with SD-OCT on an average 4.5 months (range, 2-6) after undergoing pars plana vitrectomy, internal limiting membrane peeling, and gas injection for closure of idiopathic MH. A subset of 4 eyes also underwent simultaneous imaging with AO-SLO, with one of these eyes imaged a second time 12 months after surgery.

 

Results

 

Abnormalities of the ellipsoid portion of the inner segment (ISe) band can be seen near the fovea with SD-OCT, including focal disruption, attenuation, and diffuse mottling. Areas of ISe abnormalities correspond to hyporeflective areas observed on AOSLO. Areas of hyporeflective mosaic disruption can be as small as 100 microns, and may decrease in size between 3 months and 12 months after surgery without “shifting” of the cone mosaic (see Figure 1). Hyper-reflective external limiting membrane structures were also seen with SD-OCT and AOSLO overlying focal ISe lesions.

 

Conclusions

 

Abnormalities of the ISe can be seen with SD-OCT following surgical closure of MH. These changes correspond with hyporeflective areas of cone mosaic disruption on AOSLO. Areas of hyporeflective cone mosaic disruption on AOSLO may decrease in size over time. SD-OCT and AOSLO imaging may be a useful modality to detect and monitor recovery of photoreceptor structure in eyes undergoing surgical closure of MH.

 

 

Fig. 1

 

Keywords: 586 macular holes • 550 imaging/image analysis: clinical • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)