title: Correlation Between the Dynamic Postoperative Visual Outcome and the Restoration of Foveal Microstructures After Macular Hole Surgery.
abstract: OBJECTIVE
  To analyze the long-term dynamic healing process of outer retinal changes for 1 year in patients who underwent a standard vitrectomy procedure for idiopathic macular hole (MH) repair.
  
  
  METHODS
  Retrospective, consecutive, observational case series.
  
  
  METHODS
  Data were collected on 60 eyes of 56 patients (30 women, 26 men) that underwent successful pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling for idiopathic MH from January 2011 to December 2012. The age distribution ranged from 56 to 85 years (mean: 64 years). Forty eyes underwent combined phacoemulsification, PPV, ILM peeling, and intraocular lens implantation; 20 preoperative pseudophakic eyes underwent PPV and ILM peeling only. The main outcome measures included logMAR best-corrected visual acuity (BCVA) and macular microstructures determined by spectral-domain optical coherence tomography performed pre- and postoperatively during follow-up visits at 1, 3, 6, 9, and 12 months.
  
  
  RESULTS
  One month after surgery, 24 eyes (40%) showed normal external limiting membrane (ELM), 36 eyes (60%) showed normal ELM at 3 months, and 54 eyes (90%) showed normal ELM 12 months after surgery. Six eyes (10%) revealed a continuous ellipsoid zone (EZ) at 1 month, 18 eyes (30%) at 3 months, and 48 eyes (80%) at 12 months postoperatively. There were no eyes with a disrupted ELM in the presence of an intact EZ line. The eyes with intact ELM and/or intact EZ line showed better BCVA than eyes with defects in ELM or EZ line. On the contrary, glial cell presentation is significantly associated with worse postoperative BCVA. However, the presence of foveal cystoid change is not significantly associated with postoperative BCVA.
  
  
  CONCLUSIONS
  The ELM and EZ line at the fovea recovered and the presence of glial cells and cystoid space resolved gradually after surgery. The postoperative visual acuity was correlated with resolved glial cells and a restored ELM and EZ line.
authors: Department of Ophthalmology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Yo-Chen
authors: YC
authors: Chang
authors: Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Wei-Ning
authors: WN
authors: Lin
authors: Department of Ophthalmology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Kuo-Jen
authors: KJ
authors: Chen
authors: Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Horng-Jiun
authors: HJ
authors: Wu
authors: Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Chia-Ling
authors: CL
authors: Lee
authors: Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Chia-Hui
authors: CH
authors: Chen
authors: Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Kwou-Yeung
authors: KY
authors: Wu
authors: Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: wcwu.oph@gmail.com.
authors: Wen-Chuan
authors: WC
authors: Wu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019773:Epiretinal Membrane / Q000601:surgery; D005260:Female; D005584:Fovea Centralis / Q000473:pathology*; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011184:Postoperative Period; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy