title: Association Between Insufficient Photoreceptor Layer Plugging and Postoperative Visual Outcome in the Surgically Closed Macular Hole.
abstract: OBJECTIVE
  To investigate whether the photoreceptor layer status of the detached retina, which has the potential to plug the macular hole (MH), can predict postoperative visual acuity (VA).
  
  
  METHODS
  Retrospective, consecutive, observational case series.
  
  
  METHODS
  A consecutive series of 48 eyes in 48 patients with surgically closed MHs were recruited into the study. Spectral-domain optical coherence tomography (SD OCT) images were obtained preoperatively and postoperatively. Length gaps between photoreceptor layers and the preoperative diameter of the basal MH in the detached part of the retina was calculated for the photoreceptor outer segment (OS) and the external limiting membrane (ELM). The postoperative photoreceptor layer status at the fovea, including continuity of the ELM line, inner segment ellipsoid line (ISe), and cone outer segment tip (COST) line, was categorized by graders.
  
  
  RESULTS
  The preoperative OS gap length and ELM gap length correlated significantly with postoperative VA. A larger OS or ELM gap length was associated with a more severe postoperative photoreceptor layer status. Eyes with a moderately reflective lesion had a significantly longer OS gap length and ELM gap length, significantly worse postoperative VA, and more severe photoreceptor layer status than did eyes without such a moderately reflective lesion. Eyes with a better postoperative COST status had significantly better postoperative VA (P = .0465).
  
  
  CONCLUSIONS
  OS and ELM gap length, which represent the degree of insufficiency of MH plugging, was strongly correlated with postoperative VA; moreover, these preoperative parameters were associated with the postoperative photoreceptor layer status, including glial cell proliferation.
authors: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Yu
authors: Y
authors: Kawashima
authors: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: akihito1@kuhp.kyoto-u.ac.jp.
authors: Akihito
authors: A
authors: Uji
authors: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Sotaro
authors: S
authors: Ooto
authors: Department of Ophthalmology, Saitama Medical School, Saitama, Japan.
authors: Masanori
authors: M
authors: Hangai
authors: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Yoshikatsu
authors: Y
authors: Hosoda
authors: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Nagahisa
authors: N
authors: Yoshimura
mesh_terms: D000368:Aged; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D020419:Photoreceptor Cells, Vertebrate / Q000473:pathology*; D011184:Postoperative Period; D011379:Prognosis; D012167:Retinal Perforations / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity; D014821:Vitrectomy