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Ultrahigh-Resolution Optical Coherence Tomography of Surgically Closed Macular Holes
Tony H. Ko, PhD;
Andre J. Witkin, BS;
James G. Fujimoto, PhD;
Annie Chan, BS;
Adam H. Rogers, MD;
Caroline R. Baumal, MD;
Joel S. Schuman, MD;
Wolfgang Drexler, PhD;
Elias Reichel, MD;
Jay S. Duker, MD
Arch Ophthalmol. 2006;124:827-836.
Objective To evaluate retinal anatomy using ultrahigh-resolution optical coherence tomography (OCT) in eyes after successful surgical repair of full-thickness macular hole.
Methods Twenty-two eyes of 22 patients were diagnosed as having macular hole, underwent pars plana vitrectomy, and had flat/closed macular anatomy after surgery, as confirmed with biomicroscopic and OCT examination findings. An ultrahigh-resolution–OCT system developed for retinal imaging, with the capability to achieve approximately 3-µm axial resolution, was used to evaluate retinal anatomy after hole repair.
Results Despite successful closure of the macular hole, all 22 eyes had macular abnormalities on ultrahigh-resolution–OCT images after surgery. These abnormalities were separated into the following 5 categories: (1) outer foveal defects in 14 eyes (64%), (2) persistent foveal detachment in 4 (18%), (3) moderately reflective foveal lesions in 12 (55%), (4) epiretinal membranes in 14 (64%), and (5) nerve fiber layer defects in 3 (14%).
Conclusions With improved visualization of fine retinal architectural features, ultrahigh-resolution OCT can visualize persistent retinal abnormalities despite anatomically successful macular hole surgery. Outer foveal hyporeflective disruptions of the junction between the inner and outer segments of the photoreceptors likely represent areas of foveal photoreceptor degeneration. Moderately reflective lesions likely represent glial cell proliferation at the site of hole reapproximation. Thin epiretinal membranes do not seem to decrease visual acuity and may play a role in reestablishing foveal anatomy after surgery.
Author Affiliations: Department of Electrical Engineering and Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Mass (Drs Ko and Fujimoto); New England Eye Center, Tufts–New England Medical Center, Tufts University, Boston, Mass (Mr Witkin, Ms Chan, and Drs Rogers, Baumal, Reichel, and Duker); University of Pittsburgh Medical Center Eye Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Schuman); and Christian Doppler Laboratory, Center for Biomedical Engineering and Physics, Medical University Vienna, Vienna, Austria (Dr Drexler).
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