title: Foveal microstructure and visual acuity in surgically closed macular holes: spectral-domain optical coherence tomographic analysis.
abstract: OBJECTIVE
  To evaluate reconstructive changes in foveal microstructures and identify a correlation with visual outcomes in eyes with surgically closed macular holes (MHs).
  
  
  METHODS
  Retrospective, consecutive, observational case series.
  
  
  METHODS
  Forty eyes (40 patients) with surgically closed MHs.
  
  
  METHODS
  Spectral-domain optical coherence tomography (SD-OCT) was performed to assess the foveal microstructural changes 3 and 12 months postoperatively. The correlation between the postoperative best-corrected visual acuity (BCVA) and the integrity of the foveal photoreceptor layer was evaluated.
  
  
  METHODS
  The integrity of the back-reflection lines from the photoreceptor inner segment (IS) and outer segment (OS) junction and the external limiting membrane (ELM) on SD-OCT images and the BCVA measured on the same day.
  
  
  RESULTS
  The integrity of the foveal photoreceptor layer was the only postoperative SD-OCT finding significantly associated with the 3-month BCVA (r=0.483; P=0.002). The eyes were categorized into 3 groups according to restoration of the IS/OS junction and ELM signals: 6 eyes (15%) in group A with complete restoration of the IS/OS junction and the ELM; 26 eyes (65%) in group B with a disrupted IS/OS junction and intact ELM; and 8 eyes (20%) in group C with disruption or loss of the IS/OS junction and the ELM. Although the baseline BCVA did not differ significantly (P=0.137) among groups, the mean 3-month BCVA values in groups A and B, both with reconstructed ELM with or without a restored photoreceptor IS/OS, were significantly better than in group C (P<0.05); the difference between groups A and B was not significant (P>0.05). Groups A (P=0.029) and B (P<0.001) had significant visual improvement at 12 months; group C did not have marked visual recovery. Fourteen eyes (54%) in group B had subsequent realignment of the foveal photoreceptor IS/OS; no eyes in group C had a restored IS/OS at 12 months. The presence of the ELM at 3 months is a critical structural feature significantly correlated with the BCVA at 12 months (r=0.832, P<0.001).
  
  
  CONCLUSIONS
  Reconstruction of the foveal ELM in the early postoperative period helps predict subsequent restoration of the foveal photoreceptor layer and the potential for better visual outcomes.
authors.affiliation: Department of Ophthalmology, Osaka University Medical School, Suita, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Wakabayashi
authors.forename: Maiko
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sakaguchi
authors.forename: Shunji
authors.initials: S
authors.lastname: Kusaka
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Oshima
mesh_terms: D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000473:pathology; D002387:Cataract Extraction; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D005584:Fovea Centralis / Q000473:pathology*; D006801:Humans; D007208:Indocyanine Green; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology*; D012167:Retinal Perforations / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green