Abstract
Purpose :
Functional results after surgical macular hole repair are frequently disappointing due to incomplete restoration of foveal anatomy. We report a case series with remodeling of the subfoveal ellipsoid zone (EZ) and intrafoveal gliosis following subthreshold laser after anatomical macular hole closure.
Methods :
Retrospective uncontrolled case series after successful closure of macular hole with 23 gauge vitrectomy, internal limitans membrane peeling and gas or oil tamponade. Of 5 patients, two had an idiopatic macular hole (MH) and three had a MH after prior retinal detachment (RD) repair. Subthreshold laser using Endpoint Management (n=1; 577nm PASCAL, Topcon, Japan) and/or micropulse (n=4; 577nm IQ, Iridex, USA) technology was used. The patients underwent best corrected distance visual acuity (BCVA) using a Snellen chart, complete ophthalmic examination and spectral domain optical coherence tomography (SD-OCT; Spectralis, Heidelberg Engineering, Germany). Some patients (3 of 5) were also assessed by a mesopic microperimetry (S-MAIA, Centervue, Italy).
Results :
Five eyes of 5 patients with a mean age of 64.6 years (range, 51–71 years) after surgical MH closure were analysed. Although BCVA improved at a median of 6 weeks (range 2-10) after macular hole surgery from a median of 0.96 to 0.72 LogMAR, the patients presented with an altered subfoveal EZ and intrafoveal reflectance, albeit with discernible ELM and RPE bands on OCT. All then underwent between 1-3 subthreshold laser treatments of the posterior pole (at 4 to 12 weeks intervals between session) and were observed subsequently for 3 to 6 months. All patients showed recovery of the subfoveal EZ defect after laser (median defect size 738 µm before vs. 409 µm after treatment) and improved intrafoveal retinal layer reflectance . All patients had better final visual acuity after subthreshold laser (BCVA 0.72 LogMAR before vs. 0.3 after treatment). Microperimetry confirmed central fixation after subthreshold micropulse laser in 2 of 3 subjects; 1 patient with a repaired MH after RD surgery had a BCVA of 1.5LogMAR before laser. No patient had adverse effects as a result of the subthreshold laser treatments.
Conclusions :
Subthreshold laser treatment at the posterior pole may favorably stimulate foveal remodeling after surgical MH closure beyond intrinsic retinal repair mechanisms. More work is required to validate our findings in a prospective controlled clinical trial.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.