Restoration of the photoreceptor outer segment and visual outcomes after macular hole closure: spectral-domain optical coherence tomography analysis

Graefes Arch Clin Exp Ophthalmol. 2011 Oct;249(10):1469-76. doi: 10.1007/s00417-011-1681-1. Epub 2011 Apr 17.


Background: To evaluate the prognostic value of foveal microstructures as determined using spectral-domain optical coherence tomography (SD-OCT) in eyes with surgically closed macular holes (MHs).

Methods: Thirty eyes of 30 patients that underwent successful vitrectomy for idiopathic MHs were studied. Best-corrected visual acuity (BCVA) and SD-OCT images of the fovea were examined preoperatively and at 2 weeks, 1, 3, and 6 months postoperatively. The SD-OCT characteristics evaluated included MH diameter, external limiting membrane (ELM) defect diameter, photoreceptor inner/outer segment (IS/OS) junction defect diameter, the presence or absence of subretinal fluid (SRF), central foveal thickness (CFT), and outer foveal thickness (the distance between the ELM and the inner border of the retinal pigment epithelium). The correlations between SD-OCT parameters and BCVA were analyzed.

Results: The IS/OS junction defect diameter was most strongly correlated with BCVA at 2 weeks and 1 month postoperatively while outer foveal thickness showed the strongest correlation with BCVA at 3 and 6 months. Outer foveal thickness gradually increased over the follow-up period. Among the pre- and early postoperative quantitative parameters, the only significant predictors of BCVA at 6 months were the IS/OS junction defect diameter and outer foveal thickness at 2 weeks (p = 0.012, p = 0.018, respectively). Disrupted ELM at 2 weeks was also associated with significantly poorer BCVA at 6 months (p < 0.001).

Conclusions: An increase in outer foveal thickness, indicating photoreceptor outer segment restoration, is an important factor for visual recovery after MH surgery.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Folic Acid
  • Follow-Up Studies
  • Fovea Centralis / cytology
  • Fovea Centralis / physiology
  • Humans
  • Male
  • Middle Aged
  • Recovery of Function / physiology*
  • Retinal Perforations / pathology
  • Retinal Perforations / surgery*
  • Retinal Photoreceptor Cell Outer Segment / physiology*
  • Retrospective Studies
  • Time Factors
  • Tomography, Optical Coherence / methods*
  • Treatment Outcome
  • Visual Acuity*
  • Vitrectomy / methods*


  • Folic Acid