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P.L. Winslow, B.M. Glaser; Optical Coherence Tomography and Outer Layer Reflectivity in the Evaluation of Surgically Closed Idiopathic Macular Holes in the Extended Postoperative Period . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4904.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report the characteristics of macular hole closure evaluated by optical coherence tomography (OCT) in the extended postoperative period. Methods: Five eyes of 5 patients that underwent repair of an idiopathic macular hole were examined by OCT. All eyes were treated with pars plana vitrectomy, gas tamponade, and face-down positioning. Results: The time interval between surgical repair and OCT evaluation ranged from 22 to 70 months (mean of 37.2 months). Three eyes had a visual acuity of 20/200, one with 20/100, and one with 20/30. All five eyes were noted to have closed macular holes on clinical exam, which was confirmed on OCT by the return of a smooth, concave foveal contour. In spite of the smooth, concave inner surface seen in all cases, the deeper layers of the fovea had higher reflectivity in those eyes with poorer visual outcomes. No subretinal fluid or retinal edema was noted in any of the examined eyes. Conclusions: Confirmation of closure of surgically repaired idiopathic macular holes in the extended postoperative period can be effectively achieved with optical coherence tomography. In a previous study by Takahashi and Kishi (Am J Ophthalmol 2000;130:192-196), it was suggested that visual improvement is associated with return of a normal appearing inner foveal contour. Imai and associates (Am J Ophthalmol 1999;128:621-627) also focused primarily on inner retinal contour in developing an OCT classification scheme of closed macular holes. The current findings show that the return of a normal foveal contour may be only one part of the picture. The pattern of outer layer reflectivity on OCT may be even more critical as an indicator of success.
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