title: Assessing photoreceptor structure after macular hole closure.
abstract: OBJECTIVE
  To describe photoreceptor structure and recovery after macular hole (MH) closure with pars plana vitrectomy (PPV) using adaptive optics scanning light ophthalmoscopy and spectral domain optical coherence tomography.
  
  
  METHODS
  A pilot imaging study of four eyes from four subjects undergoing PPV for MH was conducted. Imaging with spectral domain optical coherence tomography and adaptive optics scanning light ophthalmoscopy was performed at varying time points after PPV.
  
  
  RESULTS
  Despite successful MH closure, disruption of the foveal inner segment ellipsoid zone was seen in all patients when imaged at a mean of 117 days after PPV. Disruption of the photoreceptor mosaic was seen using adaptive optics scanning light ophthalmoscopy at locations corresponding to regions of ellipsoid zone disruption on spectral domain optical coherence tomography. Cone density immediately surrounding these disruptions was normal, except for one patient. In 2 patients who were imaged serially up to 516 days after PPV, recovery of cone cells within regions of mosaic disruption could be detected over time.
  
  
  CONCLUSIONS
  Photoreceptor disruption exists even after apparent MH closure. Remodeling of the foveal cone mosaic continues for many months after surgery, perhaps accounting for the delayed postoperative improvements of visual acuity in some patients. Spectral domain optical coherence tomography and adaptive optics scanning light ophthalmoscopy are useful tools for monitoring photoreceptor recovery after surgical closure of MH.
authors.affiliation: *Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin; †Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin; ‡Department of Biomedical Engineering, University of Rochester, Rochester, New York; §Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin; and ¶Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Sean
authors.initials: S
authors.lastname: Hansen
authors.forename: Sean
authors.initials: S
authors.lastname: Batson
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Weinlander
authors.forename: Robert F
authors.initials: RF
authors.lastname: Cooper
authors.forename: Drew H
authors.initials: DH
authors.lastname: Scoles
authors.forename: Peter A
authors.initials: PA
authors.lastname: Karth
authors.forename: David V
authors.initials: DV
authors.lastname: Weinberg
authors.forename: Alfredo
authors.initials: A
authors.lastname: Dubra
authors.forename: Judy E
authors.initials: JE
authors.lastname: Kim
authors.forename: Joseph
authors.initials: J
authors.lastname: Carroll
authors.forename: William J
authors.initials: WJ
authors.lastname: Wirostko
mesh_terms: D005584:Fovea Centralis / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods; D010865:Pilot Projects; D017949:Retinal Cone Photoreceptor Cells / Q000473:pathology*; D012167:Retinal Perforations / Q000473:pathology* / Q000601:surgery; D041623:Tomography, Optical Coherence; D014821:Vitrectomy / Q000379:methods