Abstract
Purpose: :
To investigate the retinal microstructures associated with the spontaneous closure of idiopathic macular holes (MH) using spectral-domain optical coherence tomography .
Methods: :
The present study included 61 patients (61 eyes; 27 men and 34 women; mean age: 64.8 years) with idiopathic MH but without any other macular abnormality, who visited the Kyoto University Hospital, Kyoto, Japan, between July 2009 and July 2011. All the patients underwent comprehensive ophthalmologic examinations, including SD-OCT, before and after closure of the MH.
Results: :
The MH closed spontaneously in 9 eyes (15%) and surgically in 52 eyes (85%). The MH of all stages closed spontaneously (stage 1b: n = 5, stage 2: n = 1, stage 3: n = 1, stage 4: n = 2). The MH minimum diameter was smaller in eyes with spontaneously closed MH (52.9 ± 71.3 μm, range 5-182 μm) than in eyes with surgically closed MH (233.8 ± 179.4 μm) (P < 0.001); however, no significant differences in the MH basal diameter and MH height were observed between the 2 groups (P = 0.132 and 0.167 respectively). In eyes with spontaneously closed MH, foveal detachment was observed in 4 eyes (44.4%) at 1 month after MH closure; however, this detachment disappeared in all eyes at the last visit. The ELM remained intact throughout the follow-up period after MH closure in all eyes with spontaneously closed MH. At the last visit, photoreceptor inner/ outer segment junction (IS/OS) disruption was observed in 3 (33.3%) eyes with spontaneous closed MH; however, it was smaller (141.7 ± 55.8μm) than that observed in eyes with surgically closed MH. The mean log-MAR visual acuity improved to 0.086 ± 0.314 after spontaneous closure, compared with that observed before the MH closure (0.387 ± 0.282) (P = 0.008).
Conclusions: :
MH with a small minimum diameter may close spontaneously. Although foveal detachment is observed after spontaneous closure, the photoreceptor layer structure can be gradually restored.
Keywords: macular holes • macula/fovea