Abstract
Purpose Internal limiting membrane (ILM) peeling is important for macular hole (MH) surgery but may have secondary effects visible on spectral domain optical coherence tomography (OCT) and multifocal electroretinography (mfERG). We relate integrity of inner and outer macular layers with functional results with mfERG. Methods Nonrandomized prospective study of 33 consecutive eyes of 33 patients with macular hole who underwent vitrectomy with ILM peeling. Best-corrected visual acuity was assessed, and integrity of external layers was measured using OCT. Each component of mfERG, N1 and P1 amplitude and latency, was also measured. Results All eyes showed macular hole closure. Visual acuity improved from 20/400 to 20/40 in the Snellen visual acuity chart (P < 0.001), and OCT external lines were intact in 19 eyes and disrupted in 14 eyes. Postoperatively, N1 and P1 amplitudes in ring 1 increased compared to preoperative values (P < 0.001 for both). Latency remained delayed for both N1 and P1 wave. In the group of 19 eyes with integrity of outer retinal layers, N1 amplitude in ring 1 was superior to the group of 14 patients with disrupted outer retinal layers (P=0.042). Conclusions In macular hole surgery, structure analysis in OCT is one of the important outcomes for the retinal surgeon. Functional results are parallel with anatomic results, but visual gain is limited. The limited recovery in mfERG suggests an alteration of retinal physiology that could explain limited vision recover.
Highlights
Macular hole is a common surgical feature, practiced in most vitreoretinal centers with high rate of closure [1]
Based on the International Society for Clinical Electrophysiology of Vision (ISCEV), multifocal electroretinography (mfERG) responses show greater amplitudes in the fovea where cone photoreceptors and bipolar cells are in greater number
In eyes with successful macular hole (MH) surgery, there is disappearance of central scotoma and improvement of visual acuity. is improvement is enhanced if there is realignment of photoreceptors and integrity of outer retinal layers. is results in N1 increase in mfERG of 66% compared to 53% increase in the disrupt photoreceptor group
Summary
Macular hole is a common surgical feature, practiced in most vitreoretinal centers with high rate of closure [1]. Peeling of the internal limiting membrane (ILM) and inverted flap technique allows this high closure rate [2]. Indications for surgery and surgical technique to be used are based on structural images. Postoperative results are based on foveal anatomy. With ocular coherence tomography (OCT), it has become much easier to define and understand the retinal anatomy before and after macular hole surgery. It has helped to explain poor visual acuity (VA) in cases where the retina appeared normal at biomicroscopic examination. Most efforts have focused on surgical technique to realign photoreceptors and improve
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