External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

Abstract

Purpose To investigate the relationship between postoperative visual acuity and integrity of the external limiting membrane (ELM) and inner segment-outer segment (IS-OS) junction layers, using spectral domain optical coherence tomography (SD-OCT), in eyes with macular holes (MHs) following surgical repair. Methods Medical charts of MH-operated cases were retrospectively identified and reviewed. The primary outcome measures were best-corrected visual acuity (BCVA) and the status of the ELM and IS-OS lines, using SD-OCT, at 6 weeks and 6 months postoperatively. Results Sixty-two eyes of 62 patients were included. At 6 weeks following surgery, out of 56 (90.3%) eyes with successful MH closure: 0 eyes showed the combination of disrupted ELM and continuous IS-OS layers; 7 eyes (12.5%) demonstrated continuity of both ELM and IS-OS (ELM c /IS-OS c group); 29 eyes (51.8%) had continuous ELM with discontinuous IS-OS layers (ELM c /IS-OS d group); and 20 eyes (35.7%) had discontinuities in both the layers (ELM d /IS-OS d group). The ELM d /IS-OS d group had the lowest visual gain at 6 months (P ¼ 0.03). At 6 months, a restoration of the integrity of IS-OS layer was observed in 51.7% eyes in the ELM c /IS-OS d group and in 5% in the ELM d /IS-OS d group (P ¼ 0.001). Conclusions When both ELM and IS-OS layers showed disruptions 6 weeks postoperatively, a significantly worse BCVA was measured at 6 months, compared with the eyes with only IS-OS disruptions, detected 6 weeks following surgery. The integrity of the ELM layer appears to be a critical factor for the restoration of the photoreceptor layer and for predicting a successful visual outcome following MH repair.

Temporal changes in foveal contour after macular hole surgery

“…Recently, an interesting phenomenon of macular migration toward the optic disc after ILM peeling for diabetic macular edema has been reported. 6 Our results also indicate that the incidence of notching and elongation was highest in the nasal direction. A certain degree of change in macular topography after ILM peeling is suspected.…”

“…In addition to the well-known phenomenon, such as restoration of the external limiting membrane and the photoreceptor layer, [1][2][3][4][5][6] the elongation of foveal tissue has recently been reported. 7 The degree of asymmetric elongation of foveal tissue after MH surgery was closely associated with metamorphopsia and found to have a negative influence on the recovery of postoperative visual function.…”

Correlation of Preoperative Retinal Pigment Epithelium Status with Foveal Microstructure in Repaired Macular Holes

“…The integrity of the photoreceptor layer has been correlated with vision after MH surgery in many studies [1,2,3,4,5,6,7,8,9,10,11,12]. Particularly, recent studies highlighted the role of an intact ELM in the prognosis of MH [1,2,3].…”

“…Particularly, recent studies highlighted the role of an intact ELM in the prognosis of MH [1,2,3]. This may be based on the inference that eyes with an intact ELM would have a greater chance for recovery of the underlying photoreceptor defect [1,2,3,10].…”

“…Optical coherence tomography (OCT) has become the gold standard for the diagnosis of MH and for confirming anatomical closure after surgery. Spectral-domain optical coherence tomography (SD-OCT) has substantially improved the visualization of foveal microstructures of the outer retina, revealing distinct hyperreflective lines, corresponding to the external limiting membrane (ELM), the inner segment/outer segment (IS/OS) junction layer, the outer segment layer, and retinal pigment epithelium (RPE) [1]. Recent reports have demonstrated that the postoperative status of the IS/OS and ELM layer significantly correlates with the visual outcome of MH surgery [1,2,3,4,5,6,7,8,9,10].…”