Features of macular hole closure in the early postoperative period using optical coherence tomography

Studying the retina in the early postoperative period after macular hole surgery is difficult because of the limitation of imaging of the fundus through a gas tamponade. Silicone oil was shown recently to be an effective alternative to gas for macular hole repair. The authors hypothesized that optical coherence tomography (OCT) could be performed through silicone oil to study early macular hole closure.

Fourteen patients with idiopathic full-thickness macular holes underwent repair, including vitrectomy and silicone fill of the vitreous cavity. Silicone oil was removed 5 to 18 weeks later in a second operative procedure. Optical coherence tomography images were obtained preoperatively (n = 14), on the first postoperative day (n = 7), after 1 week (n = 4), after 1 month (n = 14), and after silicone oil removal (n = 14).

By the first postoperative day, the retina was flat and the hole was open or closed in all patients. By 1 month, 9 of 14 patients had flat retinas and closed holes, whereas the other 5 patients had flat retinas and open holes. All patients who had an open hole after 1 month had a reopening of the hole after silicone oil removal.

Flattening of the retina with resolution of the foveal cysts after macular hole repair occurs by the first postoperative day. Closure of the horizontal retinal separation is variable but occurs by the first postoperative month in cases of successful macular hole repair. Persistent retinal separation after 1 month may be predictive of hole reopening.