Skip to main content

Advertisement

SpringerLink
Log in

Continuous changes in macular morphology after macular hole closure visualized with spectral optical coherence tomography

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To report on changes in retinal morphology during the 12 months after macular hole surgery.

Methods

Seventy one eyes of 66 patients after pars plana vitrectomy with ILM peeling and air tamponade were evaluated with spectral OCT for 12 months and additionally before surgery. Macular hole size was measured. On consecutive visits, the size of photoreceptor layer defects and elevation of the outer retinal layers were measured. Additionally, changes in foveal contour, nerve fibre layer defects, and retinal pigment epithelium defects were evaluated.

Results

Photoreceptor defects were observed in 66 eyes (93%) 1 week after surgery, and in only 21 eyes (29.5%) 12 months after surgery. The linear photoreceptor defect continuously decreased in size with time (from the mean of 882 µm 1 week after surgery to 60 µm 12 months after surgery). Elevations of the outer retinal layers were observed in 42 eyes (59%) 1 month after surgery and in six eyes (8.4%) 12 months after surgery. Nerve fibre layers defects (observed in 17 cases; 24%) and retinal pigment epithelium defects (present in four eyes, 3%) did not change with time.

Conclusions

Macular holes close with a bridge-like glial proliferation. The size of the elevation of outer retinal layers decreases with time. Photoreceptor defects get continuously smaller for at least 12 months postoperatively, which statistically significantly correlates with visual acuity improvement (p < 0.01). Additionally, foveal contour improves with time. Possible mechanisms are glial cells pushing the photoreceptors onto new positions or restoration of the outer segments from the intact photoreceptor body.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kelly NE, Wendel RT (1991) Vitreous surgery for idiopathic macular holes: results of a pilot study. Arch Ophthalmol 109:654–659

    CAS  PubMed  Google Scholar 

  2. Ullrich S, Hartiglou C, Gass C, Schaumberger M, Ulbig MW, Kampik A (2002) Macular hole size as a prognostic factor in macular hole surgery. Br J Ophthalmol 86:390–393

    Article  CAS  PubMed  Google Scholar 

  3. Mester U, Becker M (1998) Prognostic factors in surgery of macular holes. Ophthalmologe 95:158–162

    Article  CAS  PubMed  Google Scholar 

  4. Michalewska Z, Michalewski J, Cisiecki S, Adelman R, Nawrocki J (2008) Correlation between foveal structure and visual outcome following macular hole surgery: a spectral optical coherence tomography study. Graefes Arch Clin Exp Ophthalmol 246:823–830

    Article  PubMed  Google Scholar 

  5. Ko TH, Witki AJ, Fujimoto JG, Chan A, Rogers AH, Baumal CR, Schuman JS, Drexler W, Reichel E, Duker JS (2006) Ultrahigh-resolution optical coherence tomography of surgically closed macular holes. Arch Ophthalmol 24:827–836

    Article  Google Scholar 

  6. Inoue M, Watanabe Y, Arakawa A, Sato S, Kobayashi S, Kadonosono K (2009) Spectral-domain optical coherence tomography images of inner/outer segment junctions and macular hole surgery outcomes. Graefes Arch Clin Exp Ophthalmol 247:325–330

    Article  PubMed  Google Scholar 

  7. Oh J, Smiddy W, Flynn H, Gregori G, Lujan B (2010) Photoreceptor inner/outer segment defect imaging by spectral domain OCT and visual prognosis after macular hole surgery. Invest Ophthalmol Vis Sci 51:1651–1658

    Article  Google Scholar 

  8. Villate N, Lee JE, Venkatraman A, Smiddy WE (2005) Photoreceptor layer features in eyes with closed macular holes: optical coherence tomography findings and correlation with visual outcomes. Am J Ophthalmol 139:280–289

    Article  PubMed  Google Scholar 

  9. Leonard RE 2nd, Smiddy WE, Flynn HW Jr, Feuer W (1997) Long-term visual outcomes in patients with successful macular hole surgery. Ophthalmology 104:1648–1652

    PubMed  Google Scholar 

  10. Michalewska Z, Michalewski J, Adelman RA, Nawrocki J (2009) Inverted internal limiting membrane flap technique for large macular hole. Ophthalmology, in press

  11. Nawrocki J, Michalewska Z (2010) Spectral domain optical coherence tomography for macular holes. In: Holz FG, Spaide RF (ed) Essentials in Ophthalmology. Medical Retina: Focus on Retinal Imaging. Slack Inc., New York

    Google Scholar 

  12. Kang SW, Ahn K, Ham DI (2003) Types of macular hole closure and their clinical implications. Br J Ophthalmol 87:1015–1019

    Article  CAS  PubMed  Google Scholar 

  13. Imai M, Iijima H, Gotoh T, Tsukahara S (1999) Optical coherence tomography of successfully repaired idiopathic macular holes. Am J Ophthalmol 128:621–627

    Article  CAS  PubMed  Google Scholar 

  14. Tornambe PE, Poliner LS, Cohen RG (1998) Definition of macular hole surgery end points: elevated/ open, flat/open and flat/closed. Retina 18:286–287

    Article  CAS  PubMed  Google Scholar 

  15. Alpatov S, Shchuko A, Malyshev V (2007) A new method of treating macular holes. Eur J Ophthalmol 17:246–252

    CAS  PubMed  Google Scholar 

  16. Rosa RH Jr, Glaser BM, de la Cruz Z, Green WR (1996) Clinicopathologic correlation of an untreated macular hole and a macular hole treated by vitrectomy, transforming growth factor-beta 2, and gas tamponade. Am J Ophthalmol 122:853–863

    PubMed  Google Scholar 

  17. Madreperla SA, Geiger GL, Funata M, de la Cruz Z, Green WR (1994) Clinicopathologic correlation of a macular hole treated by cortical vitreous peeling and gas tamponade. Ophthalmology 101:682–686

    CAS  PubMed  Google Scholar 

  18. Funata M, Wendel RT, de la Cruz Z, Green WR (1992) Clinicopathologic study of bilateral macular holes treated with pars plana vitrectomy and gas tamponade. Retina 12:289–298

    Article  CAS  PubMed  Google Scholar 

  19. Kitaya N, Hikichi T, Kagokawa H, Takamiya A, Takahashi A, Yoshida A (2004) Irregularity of photoreceptor layer after successful macular hole surgery prevents visual acuity improvement. Am J Ophthalmol 138:308–310

    Article  PubMed  Google Scholar 

  20. Baba T, Yamamoto S, Arai M, Arai E, Sugawara T, Mitamura Y, Mizunoya S (2008) Correlation of visual recovery and presence of photoreceptor inner/outer segment junction in optical coherence images after successful macular hole repair. Retina 28:453–458

    Article  PubMed  Google Scholar 

  21. Villate N, Lee JE, Venkatraman A, Smiddy WE (2005) Photoreceptor layer features in eyes with closed macular holes: optical coherence tomography findings and correlation with visual outcomes. Am J Ophthalmol 139:280–289

    Article  PubMed  Google Scholar 

  22. Sano M, Shimoda Y, Hashimoto H, Kishi S (2009) Restored photoreceptor outer segment and visual recovery after macular hole closure. Am J Ophthalmol 147:313–318

    Article  PubMed  Google Scholar 

  23. Ducournau D, Ducournau Y (2008) A closer look at the ILM. Removal of the ILM induces a cellular response that allows the retina to fight against edema.Retinal Physician(Suppl 6):4–15

    Google Scholar 

  24. Hangai M, Ojima Y, Gotoh N, Inoue R, Yasuno Y, Makita S, Yamanari M, Yatagai T, Kita M, Yoshimura N (2007) Three-dimensional imaging of macular holes with high-speed optical coherence tomography. Ophthalmology 114:763–773

    Article  PubMed  Google Scholar 

  25. Sandberg MA, Berson E (1983) Visual acuity and cone spatial density in retinitis pigmentosa. Invest Ophthalmol Vis Sci 24:1511–1513

    CAS  PubMed  Google Scholar 

  26. Frangieh GT, Green WR, Engel HM (2005) A histopathologic study of macular cysts and holes. Retina 25:311–336

    Article  PubMed  Google Scholar 

  27. Sikorski BL, Wojtkowski M, Kaluzny JJ, Szkulmowski M, Kowalczyk A (2008) Correlation of spectral optical coherence tomography with fluorescein and indocyanine green angiography in multiple evanescent white dot syndrome. Br J Ophthalmol 92:1552–1557

    Article  CAS  PubMed  Google Scholar 

  28. Jumper JM, Gallemore RP, McCuen BW 2nd, Toth CA (2000) Features of macular hole closure in the early postoperative period using optical coherence tomography. Retina 20:232–237

    Article  CAS  PubMed  Google Scholar 

  29. Moshfeghi AA, Flynn HW Jr, Elner SG, Puliafito CA, Gass JD (2005) Persistent outer retinal defect after successful macular hole repair. Am J Ophthalmol 139:183–184

    Article  PubMed  Google Scholar 

  30. Carvounis PE, Kopel AC, Kuhl DP, Heffez J, Pepple K, Holz ER (2008) 25-gauge vitrectomy using sulfur hexafluoride and no prone positioning for repair of macular holes. Retina 28:1188–1192

    Article  PubMed  Google Scholar 

  31. Ezra E, Arden GB, Riordan-Eva P, Aylward RW, Gregor ZJ (1996) Visual field loss following vitrectomy for stage 2 and 3 macular holes. Br J Ophthalmol 80:519–525

    Article  CAS  PubMed  Google Scholar 

  32. Hutton WL, Fuller DG, Snyder WB, Fellmann RL, Swanson WH (1996) Visual field defects after macular hole surgery. A new finding. Ophthalmology 103:2152–2158

    CAS  PubMed  Google Scholar 

  33. Bopp S, Lucke K, Hille U (1997) Peripheral visual field loss after vitreous surgery for macular holes. Graefes Arch Clin Exp Ophthalmol 235:362–371

    Article  CAS  PubMed  Google Scholar 

  34. Cullinane AB, Cleary PE (2000) Prevention of visual field defects after macular hole surgery. Br J Ophthalmol 84:372–377

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ophthalmic Clinic “Jasne Blonia”, ul. Rojna 90., 91-162, Lodz, Poland

    Zofia Michalewska, Janusz Michalewski & Jerzy Nawrocki

Authors
  1. Zofia Michalewska
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janusz Michalewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jerzy Nawrocki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zofia Michalewska.

Additional information

None of the authors has any financial interest in this study

Rights and permissions

Reprints and permissions

About this article

Cite this article

Michalewska, Z., Michalewski, J. & Nawrocki, J. Continuous changes in macular morphology after macular hole closure visualized with spectral optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 248, 1249–1255 (2010). https://doi.org/10.1007/s00417-010-1370-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-010-1370-5

Keywords

Search

Navigation