External limiting membrane and visual outcome in macular hole repair: spectral domain OCT analysis

Purpose

To investigate the relationship between postoperative visual acuity and integrity of the external limiting membrane (ELM) and inner segment–outer segment (IS–OS) junction layers, using spectral domain optical coherence tomography (SD-OCT), in eyes with macular holes (MHs) following surgical repair.

Methods

Medical charts of MH-operated cases were retrospectively identified and reviewed. The primary outcome measures were best-corrected visual acuity (BCVA) and the status of the ELM and IS–OS lines, using SD-OCT, at 6 weeks and 6 months postoperatively.

Results

Sixty-two eyes of 62 patients were included. At 6 weeks following surgery, out of 56 (90.3%) eyes with successful MH closure: 0 eyes showed the combination of disrupted ELM and continuous IS–OS layers; 7 eyes (12.5%) demonstrated continuity of both ELM and IS–OS (ELM^c/IS–OS^c group); 29 eyes (51.8%) had continuous ELM with discontinuous IS–OS layers (ELM^c/IS–OS^d group); and 20 eyes (35.7%) had discontinuities in both the layers (ELM^d/IS–OS^d group). The ELM^d/IS–OS^d group had the lowest visual gain at 6 months (P=0.03). At 6 months, a restoration of the integrity of IS–OS layer was observed in 51.7% eyes in the ELM^c/IS–OS^d group and in 5% in the ELM^d/IS–OS^d group (P=0.001).

Conclusions

When both ELM and IS–OS layers showed disruptions 6 weeks postoperatively, a significantly worse BCVA was measured at 6 months, compared with the eyes with only IS–OS disruptions, detected 6 weeks following surgery. The integrity of the ELM layer appears to be a critical factor for the restoration of the photoreceptor layer and for predicting a successful visual outcome following MH repair.