Effect of Vitrectomy for Full Thickness Macular Hole on Three-Dimensional Macular Shape

Purpose: To examine whether vitrectomy surgery for macular hole alters the 3-dimensional shape of the macula. Methods: Macular shape was measured on radially oriented spectral-domain optical coherence tomography scans centered on the fovea. Eyes of patients with a macular hole were imaged before and after surgical repair. Eyes of individuals who had experienced a spontaneous posterior vitreous detachment (PVD) were also imaged. Pre- and postoperative shape was compared using the mean and range of best-fit curvature, and the difference between the best-fit curvature and retinal shape. Results: Fifty-two eyes of 17 men and 35 women with a macular hole (mean ± SD age 69.2 ± 8.0 years) were studied. The mean (±SD) axial length was 23.84 ± 1.63 mm. A successful surgical outcome was achieved in 48 of the 52 eyes. Mean (±SD) macular curvature was significantly reduced, from 0.027 ± 0.016 mm^-1 presurgery to 0.025 ± 0.015 mm^-1 postsurgery (P = .01). There were no other significant differences in macular shape measurements between the pre- and postoperative states (all P > .05). No significant change in macular shape was observed in the 28 eyes scanned before and after spontaneous PVD. Conclusions: Surgery for macular hole produces a significant reduction in macular curvature, not seen in eyes that develop a spontaneous PVD. These findings support the hypothesis that a mechanical force acts broadly across the macula in macular hole and may have implications for the area of intervention required for surgical repair.