Visual Acuity Recovery After Macular Hole Closure Associated With Foveal Avascular Zone Change

Abstract

To evaluate changes in the foveal avascular zone (FAZ) area during the postoperative period of macular hole (MH) surgery using the optical coherence tomography angiography (OCTA) and to investigate its relationship to visual acuity (VA). Methods: Consecutive unilateral MH patients who underwent successful MH closure with at least a six-month observation period were studied retrospectively. To evaluate the FAZ area, OCTA images were obtained at the preoperative visit, the first postoperative visit, and the six-month visit. Main outcome measures were postoperative FAZ change and its relationship to VA change after MH closure. Results: Fifty-one cases were studied. The FAZ area was 0.42 ± 0.11 mm 2 at the preoperative visit, 0.25 ± 0.091 mm 2 at the first postoperative visit and 0.31 ± 0.11 mm 2 at the six-month visit. FAZ area at the first postoperative visit was significantly smaller (P < 0.0001) than at the preoperative visit. FAZ area at the six-month visit was significantly greater (P < 0.0001) than at the first postoperative visit, but still significantly smaller (P = 0.0002) compared to the normal fellow eye. The postoperative FAZ area enlargement from the first postoperative visit to the six-month visit was significantly correlated with the postoperative VA recovery (P = 0.0322) and the postoperative photoreceptor reconstruction (P = 0.0213). Conclusions: The FAZ area once decreases along with MH closure; it thereafter increases toward the normal value over time. The postoperative FAZ change was correlated with the VA recovery. Translational Relevance: This study suggests that the postoperative FAZ area enlargement might be a potential biomarker indicating foveal reconstruction after MH closure.

Influence of Foveal Avascular Zone on Postoperative Visual Acuity in Macular Hole Surgery

“…As the choroidal blood ow in the macular area decreases, the avascular zone of the macular fovea will also expand to a certain extent along with the decrease in visual function. As shown in Kotaro Tsuboi et al's [3] research, this expansion is reversible, and if the macular hole is closed, the avascular zone of the macular fovea will gradually return to normal. Yoshiyuki Kita et al [11] reported that after MH closure, FAZ will signi cantly decrease, and the size of the FAZ in the affected eye will be symmetric with that in the contralateral eye.…”

“…Okumichi et al [1] found that the size of the deep FAZ is related to best-corrected visual acuity (BCVA), and Kim et al [2] reported that BCVA is signi cantly correlated with the areas of both the super cial and deep FAZ at 6 months after MH surgery. Kotaro Tsuboi et al [3] found that the FAZ area decreases temporarily after MH closure and then gradually returns to normal values, and that changes in FAZ size after surgery are related to visual recovery. Linderman et al [4] discovered a negative correlation between FAZ area measured by OCTA and axial length, but this trend can be eliminated by correcting for differences.…”