Photoreceptor layer features in eyes with closed macular holes: Optical coherence tomography findings and correlation with visual outcomes

Purpose

Study correlation between optical coherence tomography (OCT) findings and visual acuity (VA) outcomes after successful macular hole surgery (MHS).

Design

Retrospective cross-sectional study.

Methods

Postoperative OCT scans were analyzed in 34 eyes of 30 patients. Raw files of horizontal and vertical OCT scans were exported to Adobe Photoshop 7.0. Measured parameters included central foveal thickness, photoreceptor thickness, photoreceptor reflectivity, and relative reflectivity of photoreceptor to retinal pigment epithelium in the foveal area. Foveal configuration was subjectively graded.

Results

OCT scans were obtained at a median of 2 years (1 month to 10 years) postoperatively. The median visual acuity was 20/80 (20/50 to 8/200) preoperatively and 20/50 (20/20 to 5/200) postoperatively. The median foveal thickness was 198.5 μ (148 to 283). The mean (SD) photoreceptor layer thickness was 16.5 (8) μ in the 500 μ area and 17.5 (8) μ in the 1000 μ area. Mean (SD) of relative reflectivity of the photoreceptor layer was 0.60 (0.10) in both 500 μ and 1000 μ area. Postoperative VA did not correlate with foveal thickness or foveal configuration. Central (500 μ and 1000 μ) photoreceptor thickness was significantly correlated with final VA (r = .38, P = .026, each). Relative reflectivity of photoreceptors to retinal pigment epithelium in the 500 μ area was correlated with postoperative VA at a borderline significance (r = .32, P = .07). Relative reflectivity of photoreceptors to retinal pigment epithelium in the 1000 μ area was not significantly correlated with postoperative VA (r = .27, P = .12).

Conclusion

Specific retinal features can be assessed from OCT images. Morphology and thickness of the foveal photoreceptor layer correlate well with macular function after successful MHS. Outer retinal features appear to be more important to determine postoperative visual function. Inner retinal features may be more relevant for the ophthalmoscopic appearance of anatomic closure.