Foveal Microstructure And Functional Parameters In Eyes With Lamellar Macular Hole

Abstract

Purpose: : To evaluate the morphology of photoreceptor layer (by spectral-domain optical coherence tomography, SD-OCT) and the functional parameters in patients with lamellar macular hole (LMH).

Methods: : Fifty-four patients with LMH were enrolled in the study. All patients underwent a complete ophthalmological examination including best correct visual acuity (BCVA) testing (LogMar), MP1 microperimetry and SD-OCT. For each patient, 2 experienced masked observers evaluated the integrity of photoreceptors inner segment/outer segment junction (IS/OS line) and external limiting membrane (ELM line). The reliability of IS/OS line and ELM line grading was determined with weighted k statistics and intraclass correlation coefficients (ICC).

Results: : SD-OCT analysis showed in 40 eyes a complete integrity of IS/OS and ELM lines (group A), in 8 eyes a partial or complete disruption of IS/OS line with an intact ELM line (group B), and in 6 eyes an alteration of both IS/OS and ELM lines (group C). The ICC between observers for the grading of the IS/OS line was 0.955 and for the the ELM line was 0.815. The K coefficient for the status of the IS/OS line was 0.906 and for the status of the ELM line was 0.813. Mean BCVA, total retinal sensitivity, percentage of fixation points within 2 and 4 degree were significantly better in groups A and B than in group C (P < .01, Tukey-Kramer test), while there was no significant difference between group A and B (P = not significant). Mean central retinal sensitivity of Group A and B was significantly higher than Group C (P < .01, Tukey-Kramer test), and that of Group A was significantly higher than Group B (P < .05, Tukey-Kramer test). The degree of integrity of foveal photoreceptor layer was significantly correlated with mean BCVA (r = - 0.568; P < 0.000), mean central retinal sensitivity (r = 0.519; P < 0.000), total retinal sensitivity (r = 0.444; P = 0.001), but not with fixation stability inside the 2 and 4 degrees.

Conclusions: : In eyes with LMH, morphology of foveal photoreceptor layer is consistently correlated with BCVA and central retinal sensitivity. Preservation of the ELM is related to the maintenance of visual functions.

Keywords: macular holes • vitreoretinal surgery • retina