Continuous changes in macular morphology after macular hole closure visualized with spectral optical coherence tomography

Abstract

To report on changes in retinal morphology during the 12 months after macular hole surgery. Seventy one eyes of 66 patients after pars plana vitrectomy with ILM peeling and air tamponade were evaluated with spectral OCT for 12 months and additionally before surgery. Macular hole size was measured. On consecutive visits, the size of photoreceptor layer defects and elevation of the outer retinal layers were measured. Additionally, changes in foveal contour, nerve fibre layer defects, and retinal pigment epithelium defects were evaluated. Photoreceptor defects were observed in 66 eyes (93%) 1 week after surgery, and in only 21 eyes (29.5%) 12 months after surgery. The linear photoreceptor defect continuously decreased in size with time (from the mean of 882 microm 1 week after surgery to 60 microm 12 months after surgery). Elevations of the outer retinal layers were observed in 42 eyes (59%) 1 month after surgery and in six eyes (8.4%) 12 months after surgery. Nerve fibre layers defects (observed in 17 cases; 24%) and retinal pigment epithelium defects (present in four eyes, 3%) did not change with time. Macular holes close with a bridge-like glial proliferation. The size of the elevation of outer retinal layers decreases with time. Photoreceptor defects get continuously smaller for at least 12 months postoperatively, which statistically significantly correlates with visual acuity improvement (p < 0.01). Additionally, foveal contour improves with time. Possible mechanisms are glial cells pushing the photoreceptors onto new positions or restoration of the outer segments from the intact photoreceptor body.