title: LONG-TERM STRUCTURAL AND FUNCTIONAL OUTCOMES AFTER MACULAR HOLE SURGERY.
abstract: OBJECTIVE
  To assess the long-term visual outcomes of macular hole surgery and to correlate structural changes on spectral domain optical coherence tomography after surgery with long-term changes in the best-corrected visual acuity.
  
  
  METHODS
  A prospective study looking at 36 patients who underwent macular hole surgery between 2008 and 2010. The main outcome measure was change in the best-corrected visual acuity from 4 months to 6 months after surgery until the study visit. Changes in optical coherence tomography thickness and the morphology of the ellipsoid layer at the 4-month to 6-month scan were also analyzed.
  
  
  RESULTS
  Over a mean follow-up of 36 months, the best-corrected visual acuity continues to improve from a median of 20/63 at 4 months to 6 months postoperatively to a median of 20/47 at the final study visit (P < 0.01). There was a median gain of 6.5 letters (logMAR 0.13). Seven of 36 patients (20%) improved from nondriving visual acuity at 4 months to 6 months after surgery to driving visual acuity (≥20/40) at the final study visit. The presence of an intact ellipsoid layer at the 4-month to 6-month postoperative optical coherence tomography scan may represent a trend for long-term improvement in visual acuity (Fisher's exact test, P = 0.07).
  
  
  CONCLUSIONS
  The best-corrected visual acuity continues to improve beyond 4 months to 6 months after macular hole surgery. Reconstruction of the ellipsoid layer in the early postoperative period may help predict, which patients are likely to have subsequent long-term improvement in visual acuity. This information may help clinicians counsel patients appropriately and help explain cases of unsatisfactory visual improvement after surgery.
authors.affiliation: Manchester Royal Eye Hospital, Oxford Road, Manchester, United Kingdom.
authors.forename: Anand
authors.initials: A
authors.lastname: Chawla
authors.forename: Ankur
authors.initials: A
authors.lastname: Barua
authors.forename: Niall
authors.initials: N
authors.lastname: Patton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000601:surgery; D058450:Endotamponade; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina / Q000473:pathology*; D012167:Retinal Perforations / Q000503:physiopathology* / Q000601:surgery*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy