Purpose:
To assess the OCT characteristics of eyes with spontaneously closed full thickness macular hole (MH) in relation to their visual acuity (VA) outcome.
Methods:
Retrospective study of spontaneously closed MH examined with OCT 3. Among 485 eyes examined with OCT for MH between November 2000 and January 2005, we identified 14 in which the hole spontaneously closed before surgery. All eyes underwent VA measurement on a Snellen chart, fundus photographs and OCT. OCT examination comprised 6 radial scans 6 mm long, centered on the MH. Care was always taken to record the largest hole size possible, to be sure to pass through the diameter of the hole. On each scan profile, we measured the aperture and base diameter, using calipers. MH were also staged according to their vitreomacular relathionships, i.e, stage 2 for a posterior hyaloid (PH) still attached to the edge of the hole, stage 3 for a PH detached from the macular surface but not from the optic disc, and stage 4 for a complete Posterior Vitreous Detachment(PVD). After spontaneous closure of the MH, the OCT profile was examined paying special attention to the Inner Segment /Outer Segment Photoreceptor (IS/OS PR) junction line. When this line was broken (Fig) , the length of the break was measured with calipers on the 6 radial scans.
Results:
In the 14 eyes, 8 MH were stage 2 , 5 were stage 3 and only 1 was stage 4. Mean MH aperture diameter was small (161µm ± 83.0). After spontaneous closure, mean VA increased from 0.32 to 0.61. The PH was detached from the macular surface in all cases, but PVD was only complete in 4 cases. In all eyes, foveal continuity has been restored according to OCT scan profiles. However a break in the IS/OS PR junction line was present in all cases. The mean length of this break was 64 µm ± 29.6. No correlation was found either between the initial diameter of the MH and the lenghth of the break ( p = 0.68) nor between VA and the length of the break ( p = 0.09).
Conclusions:
In a small series of MH which had closed spontaneously, a break was seen in the IS/OS photoreceptor line. Despite this defect, VA improved after hole closure. A break in the IS/OS photoreceptor line may indicate of a history of spontaneously closed macular hole.
Keywords: macular holes • imaging/image analysis: clinical • photoreceptors