title: Macular hole surgery: the healing process of outer retinal layers to visual acuity recovery.
abstract: OBJECTIVE
  To evaluate optical coherence tomography (OCT) modifications of outer retinal layers as determinants for functional recovery after surgery for idiopathic macular hole (IMH).
  
  
  METHODS
  This prospective study included 23 eyes of 23 consecutive patients who underwent vitreoretinal surgery for IMH. We excluded patients with other retinal diseases. Baseline and follow-up evaluations at months 3 and 6 included complete ophthalmologic and instrumental evaluations. Functional evaluation was performed by Best Corrected Visual Acuity (BCVA) and Amsler test. Morphologic evaluation was performed by spectral-domain 3D-OCT (Topcon, Tokyo, Japan) for a deep analysis of retinal layers as well as central retinal thickness evaluation. A standard 23-G or 25-G vitreoretinal surgery was performed, completed by posterior hyaloid and inner limiting membrane peeling by means of vital dyes and gas tamponade. Statistical analysis was performed on collected data.
  
  
  RESULTS
  The mean BCVA increased significantly from 0.57 ± 0.25 logMAR at baseline to 0.34 ± 0.22 logMAR at month 6. Intraretinal layers modification showed a progressive recomposition of inner segment/outer segment layer in 91% of patients at month 6. Retinal layers recomposition showed a progressive increase in all patients during follow-up from the immediate postoperative control to the last 6-month visit.
  
  
  CONCLUSIONS
  Optical coherence tomography examination appears useful to investigate visual recovery after macular hole surgery. To ensure postsurgical functional increase, recomposition of all retinal layers, in particular in the outer retina, is mandatory. This process could be slow and not immediately observable during follow-up examinations.
authors.affiliation: Department of Surgical and Morphological Sciences, Section of Ophthalmology, School of Medicine, University of Insubria, Varese - Italy.
authors.forename: Simona M
authors.initials: SM
authors.lastname: Caprani
authors.affiliation: Department of Surgical and Morphological Sciences, Section of Ophthalmology, School of Medicine, University of Insubria, Varese - Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Donati
authors.affiliation: Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Varese - Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bartalena
authors.affiliation: Department of Surgical and Morphological Sciences, Section of Ophthalmology, School of Medicine, University of Insubria, Varese - Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Vinciguerra
authors.affiliation: Department of Ophthalmology, Polytechnic University of Ancona, Ancona - Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Mariotti
authors.affiliation: Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Second University of Naples, Naples - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Testa
authors.affiliation: Department of Clinical and Experimental Medicine, University of Insubria, Varese - Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Porta
authors.affiliation: Department of Surgical and Morphological Sciences, Section of Ophthalmology, School of Medicine, University of Insubria, Varese - Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Azzolini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019773:Epiretinal Membrane / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D012167:Retinal Perforations / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D055211:Retinal Photoreceptor Cell Inner Segment / Q000473:pathology; D055214:Retinal Photoreceptor Cell Outer Segment / Q000473:pathology; D055213:Retinal Pigment Epithelium / Q000473:pathology; D041623:Tomography, Optical Coherence / Q000379:methods; D014792:Visual Acuity / Q000502:physiology*; D014821:Vitrectomy / Q000379:methods