Evolution and visual outcomes of outer foveolar lucency after surgery for large idiopathic macular hole.

Abstract

To explore the evolution of outer foveolar lucency (OFL) after vitrectomy and the correlation between OFL and visual acuity (VA) outcome in eyes with large idiopathic macular hole (IMH). In this retrospective study, 244 eyes of 233 subjects with large IMH (diameter > 400μm), who underwent vitrectomy, were included. Preoperative clinical data, postoperative optical coherence tomography (OCT) images, and VA at 1-, 4-, and 10-month visits were documented. The prevalence, incidence, and width of OFL and their correlation with postoperative VA were analyzed. The prevalence of OFL was 10.4% (24/231) at 1month and significantly increased to 30.4% (55/181) at 4months (P < 0.001) and 34.2% (25/73) at 10months (P < 0.001). The incidence was 26.1% (40/153) and 22.0% (9/41) at 4 and 10months, respectively. OFL appeared at 1month while disappeared at 4 or 10months in 8 eyes (50.0%). The presence of OFL at 1month was negatively associated with IMH diameter (Nagelkerke R2 = 0.06; P = 0.02). Eyes with OFL at 4months had better VA at their 4-month visit than eyes without OFL (P = 0.02). Eyes with early-developed OFLs had better VA at 10months than those with later-developed ones (P = 0.02). Width of OFL was not associated with postoperative VA at any point. OFL is not rare in eyes with large IMH after surgery. It can occur gradually and remain during the 10-month follow-up. The presence of OFL appears to have no negative impact on the postoperative VA and it may represent the remodeling of foveal photoreceptors.