The value of combining autofluorescence and optical coherence tomography in predicting the visual prognosis of sealed macular holes

Am J Ophthalmol. 2013 Jul;156(1):149-156.e1. doi: 10.1016/j.ajo.2013.02.005. Epub 2013 Apr 28.


Purpose: To investigate the autofluorescence patterns of sealed macular holes and determine the correlations of the postoperative changes in spectral-domain optical coherence tomography and fundus autofluorescence (FAF) with the best-corrected visual acuity (BCVA) of patients with sealed idiopathic macular holes.

Design: Retrospective consecutive observational case series.

Methods: Seventy-seven eyes from 75 consecutive patients who had undergone successful vitrectomies for idiopathic macular holes by a single surgeon with postoperative follow-ups for over 1 year were included. FAF imaging studies were performed 1 month and 6 months post surgery, and optical coherence tomography (OCT) was performed at regular intervals after surgery. The main outcome measures were macular hole size, FAF patterns, retina outer segment from OCT, and BCVA before and after operation.

Results: The patients who had intact external limiting membranes (ELMs) at 1 month after surgery had better BCVAs than those without (P < .001), regardless of the photoreceptor inner segment/outer segment (IS/OS) condition. The FAF patterns were divided into 3 groups: homogenous hyperfluorescence, patchy hyperfluorescence, and normal hypofluorescence. No significant BCVA differences were noted (P = .28) among the 3 groups. However, significantly better BCVAs were noted in the patients who had both intact ELMs and normal hypofluorescence patterns (P = .011).

Conclusions: In sealed macular holes, intact ELMs predicted good postoperative BCVA. In this subgroup, a hypofluorescence pattern on the FAF imaging predicted the best postoperative BCVA.

MeSH terms

  • Adult
  • Aged
  • Basement Membrane / surgery
  • Endotamponade
  • Female
  • Fluorescein Angiography*
  • Fluorocarbons / administration & dosage
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Prone Position
  • Retinal Perforations / physiopathology
  • Retinal Perforations / surgery*
  • Retinal Photoreceptor Cell Inner Segment / pathology
  • Retinal Photoreceptor Cell Outer Segment / pathology
  • Retrospective Studies
  • Tomography, Optical Coherence*
  • Treatment Outcome
  • Triamcinolone Acetonide
  • Visual Acuity / physiology*
  • Vitrectomy


  • Fluorocarbons
  • perflutren
  • Triamcinolone Acetonide