Foveal microstructure on spectral-domain optical coherence tomographic images and visual function after macular hole surgery

Am J Ophthalmol. 2011 Aug;152(2):283-290.e1. doi: 10.1016/j.ajo.2011.02.001. Epub 2011 Jun 12.


Purpose: To determine the correlation between the recovery of foveal microstructure and the visual acuity or the foveal sensitivity after idiopathic macular hole (MH) closure.

Design: Prospective, consecutive, observational case series.

Methods: We studied 43 eyes of 43 patients before and 1, 3, and 6 months after MH surgery. The best-corrected visual acuity (BCVA), the foveal sensitivity measured by MP1 microperimetry, and the photoreceptor inner and outer segment (IS/OS) junction and the external limiting membrane (ELM) determined by spectral-domain optical coherence tomography were investigated.

Results: Preoperatively, the lengths of the IS/OS junction defect and the ELM defect were significantly correlated with only the foveal sensitivity (P<.0001). At all postoperative times, the lengths of both the IS/OS and ELM defects were significantly correlated with both the BCVA and the foveal sensitivity (P<.05 for all). The preoperative lengths of both the IS/OS and ELM defects were significantly correlated with the foveal sensitivity at 6 months after surgery (P=.0022, P=.0031, respectively). The IS/OS junction defect was significantly correlated with the ELM defect at all times (P<.0001 for all). No restoration of the IS/OS junction was observed in eyes without the ELM restoration.

Conclusions: The restoration of the ELM is closely associated with that of the IS/OS junction. The preoperative IS/OS or ELM defect was associated with the postoperative foveal sensitivity. The restoration of not only the IS/OS junction but also the ELM may reflect the morphologic and functional recovery of the foveal photoreceptors in surgically closed MHs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Basement Membrane / surgery
  • Endotamponade
  • Female
  • Follow-Up Studies
  • Fovea Centralis / pathology*
  • Humans
  • Lens Implantation, Intraocular
  • Male
  • Middle Aged
  • Phacoemulsification
  • Photoreceptor Cells, Vertebrate / pathology
  • Postoperative Period
  • Prone Position
  • Prospective Studies
  • Recovery of Function
  • Retinal Perforations / physiopathology*
  • Retinal Perforations / surgery*
  • Sulfur Hexafluoride / administration & dosage
  • Tomography, Optical Coherence*
  • Tonometry, Ocular
  • Visual Acuity / physiology*
  • Visual Field Tests
  • Vitrectomy


  • Sulfur Hexafluoride