Fixation patterns of idiopathic macular holes after vitreous surgery.
BACKGROUND
Evaluation of idiopathic macular holes with the scanning laser ophthalmoscope (SLO) has shown fixation to be located at or near the margin of the hole and above the horizontal meridian in most cases. However, changes between preoperative and postoperative fixation have not been well studied.


METHODS
We used SLO microperimetry to determine scotomas and fixation points in 13 patients with idiopathic macular holes before and after vitreous surgery. The distance between preoperative and postoperative fixation points and the direction of movement were measured.


RESULTS
Preoperatively, fixation was found to be at or near the margin of the macular hole in all eyes and was located above the horizontal meridian in most (84.6%) eyes. Postoperatively, there was a shift in the position of the fixation points. The distance between preoperative and postoperative fixation correlated with the degree of visual improvement (P = 0.032), but the direction of movement was variable.


CONCLUSIONS
A shift in the position of fixation occurs after macular hole surgery, and the amount of shift correlates with visual improvement. From this observation, we define the term functional macular hole closure, characterized by centripetal movement of the neurosensory retina and improvement in vision, and the broader term anatomic macular hole closure, in which apparent hole closure may result from gliosis in the absence of movement of the neurosensory retina, not associated with visual improvement.
Nakabayashi
M
M
Department of Ophthalmology, Osaka University Medical School, Japan.
Fujikado
T
T
Ohji
M
M
Saito
Y
Y
Tano
Y
Y
D000328:Adult; D000368:Aged; D005260:Female; D005403:Fixation, Ocular / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods; D012167:Retinal Perforations / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D012607:Scotoma / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity; D058609:Visual Field Tests; D014821:Vitrectomy