Intraoperative OCT Findings May Predict Postoperative Visual Outcome in Eyes with Idiopathic Macular Hole

To determine the significance of correlation between the intraoperative OCT findings and postoperative retinal morphologic and physiologic features in eyes with an idiopathic macular hole (MH).

Retrospective, interventional case-control study.

Pars plana vitrectomy with internal limiting membrane (ILM) peeling and air tamponade was performed on 33 eyes with idiopathic MHs. All of the eyes were followed up for at least 6 months.

The intraoperative OCT (Rescan; Carl Zeiss Meditec, Oberkochen, Germany) images were used to detect the presence of residual fragments at the edge of the MH, and the eyes were divided into those with residual fragments (the residual group) and those without residual fragments (the nonresidual group).

The preoperative and postoperative OCT (Spectralis; Heidelberg Engineering, Heidelberg, Germany) findings and visual acuities were compared. The area of the hyperreflective tissue at the inner layer of the closed MH was measured with ImageJ software (National Institutes of Health, Bethesda, MD).

Residual fragments were detected in 22 eyes (67%), including 3 eyes with residual ILM fragments, and were not detected in 11 eyes. Age, gender, preoperative vision, refractive errors, and axial length were not significantly different between the 2 groups. The presence of residual fragments was associated significantly with the presence of epiretinal membrane (P = 0.040) and with epiretinal membrane, epiretinal proliferation, or both (P = 0.007) in the preoperative OCT images. However, they were not associated significantly with the presence of epiretinal proliferation and ILM fragments. The MHs were closed after surgery in all eyes with type 1 closure. Postoperative vision was significantly worse in the residual group at 3 and 6 months (P = 0.029 and P = 0.037, respectively). The sizes of the hyperreflective inner retinal tissue were significantly larger in the residual group than those in the nonresidual group at 1 and 3 months after surgery (P < 0.01). The sizes of the tissue decreased significantly after surgery in the residual group (P < 0.001) but not in the nonresidual group.

The residual fragments detected at the edge of the MH by intraoperative OCT may be the hyperreflective tissue observed in closed MHs and are predictors of limited postoperative visual improvements.