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Y. Itoh, D. Kunita, A. Sugitani, T. Hiraoka, M. Inoue, D. Miki, A. Hirakata; Evaluation of Anatomical Hole Closure and Visual Outcomes After Pars Plana Vitrectomy for Macular Hole Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2564.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the visual outcomes and fundus autofluorescence (FAF) for macular hole retinal detachment (MHRD) after pars plana vitrectomy (PPV) in three types of macular hole closure classified with spectral domain optical coherence tomography (SD-OCT).
Twenty-eight eyes of 28 patients with MHRD that underwent PPV with concomitant internal limiting membrane peeling and achieved total retinal reattachment at the last follow-up examination at least 3 months were reviewed retrospectively. The postoperative states of macular hole closure was classified with SD-OCT (OCT4000, Carl Zeiss Meditec) in three groups; macular hole closure with the outer retinal layer remained (group A), macular hole closure but outer retinal layer was absent, replaced with hyperreflective tissue (group B), and macular hole failed to close (group C). FAF imaging whether macular hole lesion was hypofluorescent (closed macular hole) or hyperfluorescent (opened macular hole) and best-corrected visual acuity (BCVA) were compared in types of macular hole.
Five eyes (18%) were classified into group A, 3 eyes into group B, and 20 eyes (71%) into group C. Hypofluorescence at the macular hole in FAF were seen in 2 (67%) of 3 eyes in group A and 2 (100%) of 2 eyes in group B. Hyperfuorescence at the macular hole were seen in 5 (50%) of 10 eyes in type C, but the other 5 eyes showed hypofluorescence due to chorioretinal atrophy including the fovea. In all three groups, postoperative BCVA was better than preoperative BCVA, but were not significant. However, postoperative BCVA > 20/40 was seen only in 2 eyes (40%) of group A.
Postoperative BCVA improved in most of the cases after reattachment of MHRD. The macular hole closure with remained outer retinal layer may be important to achieve visual recovery of BCVA >20/40 after MRHD repair. Discrimination of macular hole closure by FAF may be useful as an adjunctive method but it was influenced by the existence of chorioretinal atrophy.
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