Tomographic Features of Macula After Successful Macular Hole Surgery

PURPOSE. We determined the retinal features associated with a dissociated optic nerve fiber layer (DONFL) appearance after successful macular hole surgery with internal limiting membrane (ILM) peeling. METHODS. A tota of 47 eyes of 47 patients who underwent pars plana vitrectomy with ILM peeling was examined by spectral-domain optical coherence tomography (SD-OCT). RESULTS. A DONFL appearance was found in 31 (66.0%) eyes on color fundus photography. The postoperative best-corrected visual acuity and its improvements were not significantly different between eyes with and without this appearance. The SD-OCT images showed small inner retinal defects corresponding to each arcuate stria in all eyes with the DONFL appearance. Of these eyes, 25 (80.6%) included inner retinal defects extending beyond the retinal nerve fiber layer (RNFL) into the ganglion cell layer and inner plexiform layer. Similar inner retinal defects were seen in 14 (87.5%) of the 16 eyes without a DONFL appearance; 10 eyes (62.5%) included the defects that extended deeper than the RNFL. Such deep defects were found more frequently in the temporal than in the other quadrants (P < 0.0001). In 10 eyes that underwent Micro Perimeter-1, a reduction in retinal sensitivity (< 10 dB) was found in 20 (10.4%) of the 192 points on arcuate striae, but only in 7 (3.4%) of 208 points away from the striae (P = 0.005). CONCLUSIONS. Macular hole surgery with ILM peeling may lead to deep inner retinal damage regardless of the development of the DONFL appearance detected on color fundus photography.