title: Photoreceptor damage and foveal sensitivity in surgically closed macular holes: an adaptive optics scanning laser ophthalmoscopy study.
abstract: OBJECTIVE
  To assess photoreceptor structure using adaptive optics scanning laser ophthalmoscopy (AO SLO) and spectral-domain optical coherence tomography (SD OCT) and to evaluate the relationship between structural abnormalities and foveal sensitivity in eyes with surgically closed macular hole (MH).
  
  
  METHODS
  Prospective, interventional case series.
  
  
  METHODS
  Twenty-one eyes of 19 patients with idiopathic MH underwent a full ophthalmologic examination, including SD OCT at baseline. Imaging with SD OCT, an original prototype AO SLO system, and microperimetry were performed at 6 months after surgery.
  
  
  RESULTS
  All patients underwent anatomically successful MH closure. On AO SLO, dark areas (0.004 to 0.754 mm(2)) were seen in all eyes after MH repair. Lower cone density correlated with poorer postoperative visual acuity and lower mean foveal sensitivity (both P < .001). Larger dark areas on AO SLO correlated with poorer postoperative visual acuity (P = .003) and lower mean foveal sensitivity (P = .006). Cone density was significantly lower and dark areas were significantly larger in eyes that had defects of the outer segments in the fluid cuff before surgery (P = .018 and P = .001, respectively) and moderately reflective foveal lesions after surgery (P < .001 and P < .001, respectively). Larger dark areas correlated with longer symptom duration before surgery (P < .001).
  
  
  CONCLUSIONS
  Structural damage to the photoreceptor layer correlated with greater decreases in visual function in eyes with surgically closed MH. AO SLO imaging is a useful and quantitative tool for detecting photoreceptor abnormalities and their association with visual acuity and retinal sensitivity in eyes with closed MH.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. ohoto@kuhp.kyoto-u.ac.jp
authors.forename: Sotaro
authors.initials: S
authors.lastname: Ooto
authors.forename: Masanori
authors.initials: M
authors.lastname: Hangai
authors.forename: Kohei
authors.initials: K
authors.lastname: Takayama
authors.forename: Naoko
authors.initials: N
authors.lastname: Ueda-Arakawa
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hanebuchi
authors.forename: Nagahisa
authors.initials: N
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000601:surgery; D058450:Endotamponade; D005260:Female; D005584:Fovea Centralis / Q000502:physiology*; D006801:Humans; D007834:Lasers; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology*; D016684:Prone Position; D011446:Prospective Studies; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*; D058609:Visual Field Tests; D014821:Vitrectomy