Prognostic significance of delayed structural recovery after macular hole surgery.
OBJECTIVE
To assess the prognostic significance for visual function of persistent subfoveal fluid and persistent photoreceptor layer discontinuity in eyes in which hole closure had been obtained 3 months after macular hole surgery.


METHODS
Ancillary study of subjects enrolled in a randomized clinical trial.


METHODS
Participants were recruited from a randomized clinical trial evaluating internal limiting membrane (ILM) peeling in macular hole surgery. The study included 74 eyes in which a contiguous retinal surface or a full attachment with a flat neuroretinal rim had been reestablished after macular hole surgery.


METHODS
Contrast-enhanced optical coherence tomography was used to detect closure defects involving substrata of the retina with particular emphasis on the photoreceptor layer. Outcomes were compared with best-corrected visual acuity (BCVA) 12 months after surgery.


METHODS
Postoperative foveal configuration and foveal photoreceptor layer discontinuity diameter 3 months after macular hole surgery.


RESULTS
Persistent subfoveal fluid 3 months after macular hole surgery, which was found in 36.5% of eyes, was not associated with a significantly different BCVA after 12 months compared with eyes with a fully attached fovea at 3 months (70.9 letters vs. 72.0 letters; P = 0.59). Receiver operating characteristics curve analysis identified persistent photoreceptor layer discontinuity of a diameter of more than 1477 microm after 3 months to be associated with poorer BCVA after 12 months (P<0.001), yet an overall reduction in discontinuity diameter from 3 to 12 months (P<0.001) was not correlated with a concurrent improvement in BCVA (r = -0.040; P = 0.81). Persistence of fluid and diameter of discontinuity at 3 months were not related to whether ILM peeling was used; however, secondary macular hole surgery had a significant influence on diameter of photoreceptor layer discontinuity at 3 months.


CONCLUSIONS
Structural recovery in the form of photoreceptor layer discontinuity with a diameter of more than approximately 1500 microm 3 months after macular hole surgery was associated with poorer visual acuity after 12 months than less extensive discontinuity. Subfoveal fluid persisting after 3 months had disappeared after 12 months in all but 5 of 74 eyes and had no effect on final visual outcome.
Christensen
Ulrik C
UC
Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark. ulrikchristensen@dadlnet.dk
Krøyer
Kristian
K
Sander
Birgit
B
Larsen
Michael
M
la Cour
Morten
M
D001485:Basement Membrane / Q000601:surgery; D004396:Coloring Agents; D005122:Exudates and Transudates; D006801:Humans; D007208:Indocyanine Green; D011379:Prognosis; D012372:ROC Curve; D020127:Recovery of Function; D012160:Retina / Q000503:physiopathology*; D012167:Retinal Perforations / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy
D004396:Coloring Agents; D007208:Indocyanine Green