Foveal Shape after Idiopathic Macular Hole Surgery with and without Internal Limiting Membrane Removal

Long‐term functional outcome of macular hole surgery correlated to optical coherence tomography measurements

“…In postoperative OCT examinations, the foveal contour was graded normal in only 37% and abnormal or shallow in 63% of cases in our series. This stands in contrast to other reports describing a regular foveal contour in 93% 15 or 91% 16 of cases after ILM peeling; these percentages appear rather high as one might expect the foveal contour to be rarely normal after macular hole surgery. However, we hypothesize that the difference concerning the morphological appearance of the fovea observed in our study might be due to the longer follow up of our patients with glial cell proliferation around the fovea in the postoperative course resulting in discrete distortions of the retinal architecture.…”

“…A correlation of foveal thickness and best corrected VA was previously described 17 . As in other reports, 15,16 , 18 the thickness or shape of the fovea in OCT images did not correlate with best corrected VA in our patients.…”

“…However, we hypothesize that the difference concerning the morphological appearance of the fovea observed in our study might be due to the longer follow up of our patients with glial cell proliferation around the fovea in the postoperative course resulting in discrete distortions of the retinal architecture. An alteration of the foveal contour documented during follow up had been described in macular hole patients after surgery without ILM peeling 15 . Of note we were only able to clearly identify epiretinal membrane formation in three patients in postoperative OCT.…”

“…Complications associated with this procedure seemed to be limited to defects of the nerve fibre layer resulting in small asymptomatic paracentral scotomata 3 and a selective delay of recovery of the FMERG b‐wave suggesting a discrete alteration of retinal physiology but without any influence on VA 14 . It had also been discussed that ILM removal might prevent late recurrences of macular holes and epiretinal cellular proliferations 15,16 . The improvement of VA after surgery does not always meet the expectations based on the anatomic success and the clinical examination of the macular area in some patients.…”

“…13 Complications associated with this procedure seemed to be limited to defects of the nerve fibre layer resulting in small asymptomatic paracentral scotomata 3 and a selective delay of recovery of the FMERG b-wave suggesting a discrete alteration of retinal physiology but without any influence on VA. 14 It had also been discussed that ILM removal might prevent late recurrences of macular holes and epiretinal cellular proliferations. 15,16 The improvement of VA after surgery does not always meet the expectations based on the anatomic success and the clinical examination of the macular area in some patients. Improved The correlation of preoperative OCT findings such as the HFF and base diameter of the macular hole and final VA was very much in line with our previous investigation 5 showing that large base diameters are associated with less favourable and high HFF values with better functional outcome.…”