Restored Photoreceptor Outer Segment and Visual Recovery After Macular Hole Closure

PURPOSE: To evaluate restoration of the photoreceptor outer segment and visual outcomes in closed macular holes. DESIGN: Retrospective case series. METHODS: We retrospectively observed the reparative process of macular holes in 28 eyes one, three, and six months postoperatively using spectral-domain optical coherence tomography. We evaluated the reflective line at the junction between the photoreceptor inner and outer segment (IS/OS) and the best corrected visual acuity (BCVA). RESULTS: The outer photoreceptor layer showed a foveal detachment, a disrupted IS/OS line, or both one month postoperatively. No eye had a continuous IS/OS line. These abnormalities were gradually restored at various levels. At six months, nine eyes had a normal outer photoreceptor layer, four eyes outer foveal defects with a continuous ISMS line, 12 eyes a disrupted IS/OS line, and three eyes outer foveal defects with a disrupted IS/OS line. The mean BCVAs were significantly (P = .017) lower in groups with a disrupted IS/OS line compared to groups with a continuous IS/OS line with or without outer foveal defects. CONCLUSIONS: Macular hole closure is attained by bridge formation (foveal detachment) and the IS/OS line heals in varying degrees. The visual outcomes were significantly better in eyes with a continuous IS/OS line than in those with a disrupted IS/OS line. (Am J Ophthalmol 2009;147:313-318. (C) 2009 by Elsevier Inc. All rights reserved.)