title: Prognostic significance of delayed structural recovery after macular hole surgery.
abstract: 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.
authors.affiliation: Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark. ulrikchristensen@dadlnet.dk
authors.forename: Ulrik C
authors.initials: UC
authors.lastname: Christensen
authors.forename: Kristian
authors.initials: K
authors.lastname: Krøyer
authors.forename: Birgit
authors.initials: B
authors.lastname: Sander
authors.forename: Michael
authors.initials: M
authors.lastname: Larsen
authors.forename: Morten
authors.initials: M
authors.lastname: la Cour
mesh_terms: 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
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green