Residual defect in the foveal photoreceptor layer detected by optical coherence tomography in eyes with spontaneously closed macular holes

PURPOSE: To assess the optical coherence tomography (OCT) characteristics of spontaneously closed macular hole (MH). DESIGN: Retrospective observational case series. METHODS: Among 5 10 consecutive eyes examined for an MH before surgery, we retrospectively identified 14 eyes in which the MH closed spontaneously before the operation. At the time of diagnosis, Snellen visual acuity (VA) was measured and all 14 eyes underwent OCT 1 or OCT3. The aperture and base diameters of the MHs were recorded. After spontaneous MH closure, VA was measured again and OCT3 was performed in all eyes. The photoreceptor (PR) inner segment-outer segment (IS-OS) junction line was examined to measure any residual defect at the foveal center. RESULTS: Mean MH aperture diameter was small, less than 400 mu m (mean +/- standard deviation [SD], 161.8 +/- 83.0 mu m). After spontaneous closure, mean VA increased from 0.3 to 0.6. In all 14 eyes, foveal continuity was restored on OCT scans. However, a defect in the photoreceptor IS-OS junction layer ranging from 25 to 110 mu m (mean +/- SD, 64.1 +/- 29.6 mu m) was present in all eyes. No correlation was found, either between MH aper ture diameter and the width of the PR defect (P = .68) or between VA and the width of the defect (P = .09). CONCLUSIONS: In a series of 14 MHs that had closed spontaneously, a defect was seen in the photoreceptor IS-OS junction line, although VA improved in all eyes. When this configuration is seen in elderly patients without a history of MH, it may be taken as evidence of spontaneous closure of an undiagnosed MH.