HOLE-DOOR SIGN: A Novel Intraoperative Optical Coherence Tomography Feature Predicting Macular Hole Closure

To describe a novel intraoperative finding during pars plana vitrectomy for macular hole using operating microscope-integrated spectral domain optical coherence tomography that predicts the closure of macular hole.

Twenty-five eyes of 25 patients with macular hole, who underwent 25-gauge pars plana vitrectomy over a period of 16 months at a tertiary eye care center by a single surgeon, were recruited in this retrospective interventional study. All eyes were assessed with intraoperative spectral domain optical coherence tomography before and after internal limiting membrane peeling. The patients were assessed in terms of best-corrected visual acuity, preoperative minimal hole diameter, and type of hole closure.

After the internal limiting membrane was peeled, vertical pillars of tissue were seen at the edges of hole projecting into the vitreous cavity. This appearance was similar to that of an open door over the macular hole and was termed "hole-door sign." Hole-door sign was seen in 15 of 25 eyes (60%). All the eyes with hole-door sign had Type-1 closure of macular hole (100%), whereas only 6 of 10 eyes (60%) without hole-door sign had Type-1 closure of the macular hole.

Hole-door sign is a novel intraoperative finding that predicts postoperative Type-1 closure of macular hole. This may add to the utility of intraoperative optical coherence tomography in clinical practice.