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Correlation Between the Dynamic Postoperative Visual Outcome and the Restoration of Foveal Microstructures After Macular Hole Surgery.
Am J Ophthalmol. 2015 Jul; 160(1):100-6.e1.AJ

Abstract

PURPOSE

To analyze the long-term dynamic healing process of outer retinal changes for 1 year in patients who underwent a standard vitrectomy procedure for idiopathic macular hole (MH) repair.

DESIGN

Retrospective, consecutive, observational case series.

METHODS

Data were collected on 60 eyes of 56 patients (30 women, 26 men) that underwent successful pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling for idiopathic MH from January 2011 to December 2012. The age distribution ranged from 56 to 85 years (mean: 64 years). Forty eyes underwent combined phacoemulsification, PPV, ILM peeling, and intraocular lens implantation; 20 preoperative pseudophakic eyes underwent PPV and ILM peeling only. The main outcome measures included logMAR best-corrected visual acuity (BCVA) and macular microstructures determined by spectral-domain optical coherence tomography performed pre- and postoperatively during follow-up visits at 1, 3, 6, 9, and 12 months.

RESULTS

One month after surgery, 24 eyes (40%) showed normal external limiting membrane (ELM), 36 eyes (60%) showed normal ELM at 3 months, and 54 eyes (90%) showed normal ELM 12 months after surgery. Six eyes (10%) revealed a continuous ellipsoid zone (EZ) at 1 month, 18 eyes (30%) at 3 months, and 48 eyes (80%) at 12 months postoperatively. There were no eyes with a disrupted ELM in the presence of an intact EZ line. The eyes with intact ELM and/or intact EZ line showed better BCVA than eyes with defects in ELM or EZ line. On the contrary, glial cell presentation is significantly associated with worse postoperative BCVA. However, the presence of foveal cystoid change is not significantly associated with postoperative BCVA.

CONCLUSIONS

The ELM and EZ line at the fovea recovered and the presence of glial cells and cystoid space resolved gradually after surgery. The postoperative visual acuity was correlated with resolved glial cells and a restored ELM and EZ line.

Authors+Show Affiliations

Department of Ophthalmology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.Department of Ophthalmology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: wcwu.oph@gmail.com.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25817009

Citation

Chang, Yo-Chen, et al. "Correlation Between the Dynamic Postoperative Visual Outcome and the Restoration of Foveal Microstructures After Macular Hole Surgery." American Journal of Ophthalmology, vol. 160, no. 1, 2015, pp. 100-6.e1.
Chang YC, Lin WN, Chen KJ, et al. Correlation Between the Dynamic Postoperative Visual Outcome and the Restoration of Foveal Microstructures After Macular Hole Surgery. Am J Ophthalmol. 2015;160(1):100-6.e1.
Chang, Y. C., Lin, W. N., Chen, K. J., Wu, H. J., Lee, C. L., Chen, C. H., Wu, K. Y., & Wu, W. C. (2015). Correlation Between the Dynamic Postoperative Visual Outcome and the Restoration of Foveal Microstructures After Macular Hole Surgery. American Journal of Ophthalmology, 160(1), 100-e1. https://doi.org/10.1016/j.ajo.2015.03.019
Chang YC, et al. Correlation Between the Dynamic Postoperative Visual Outcome and the Restoration of Foveal Microstructures After Macular Hole Surgery. Am J Ophthalmol. 2015;160(1):100-6.e1. PubMed PMID: 25817009.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correlation Between the Dynamic Postoperative Visual Outcome and the Restoration of Foveal Microstructures After Macular Hole Surgery. AU - Chang,Yo-Chen, AU - Lin,Wei-Ning, AU - Chen,Kuo-Jen, AU - Wu,Horng-Jiun, AU - Lee,Chia-Ling, AU - Chen,Chia-Hui, AU - Wu,Kwou-Yeung, AU - Wu,Wen-Chuan, Y1 - 2015/03/27/ PY - 2015/01/02/received PY - 2015/03/21/revised PY - 2015/03/23/accepted PY - 2015/3/31/entrez PY - 2015/3/31/pubmed PY - 2015/8/22/medline SP - 100 EP - 6.e1 JF - American journal of ophthalmology JO - Am J Ophthalmol VL - 160 IS - 1 N2 - PURPOSE: To analyze the long-term dynamic healing process of outer retinal changes for 1 year in patients who underwent a standard vitrectomy procedure for idiopathic macular hole (MH) repair. DESIGN: Retrospective, consecutive, observational case series. METHODS: Data were collected on 60 eyes of 56 patients (30 women, 26 men) that underwent successful pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling for idiopathic MH from January 2011 to December 2012. The age distribution ranged from 56 to 85 years (mean: 64 years). Forty eyes underwent combined phacoemulsification, PPV, ILM peeling, and intraocular lens implantation; 20 preoperative pseudophakic eyes underwent PPV and ILM peeling only. The main outcome measures included logMAR best-corrected visual acuity (BCVA) and macular microstructures determined by spectral-domain optical coherence tomography performed pre- and postoperatively during follow-up visits at 1, 3, 6, 9, and 12 months. RESULTS: One month after surgery, 24 eyes (40%) showed normal external limiting membrane (ELM), 36 eyes (60%) showed normal ELM at 3 months, and 54 eyes (90%) showed normal ELM 12 months after surgery. Six eyes (10%) revealed a continuous ellipsoid zone (EZ) at 1 month, 18 eyes (30%) at 3 months, and 48 eyes (80%) at 12 months postoperatively. There were no eyes with a disrupted ELM in the presence of an intact EZ line. The eyes with intact ELM and/or intact EZ line showed better BCVA than eyes with defects in ELM or EZ line. On the contrary, glial cell presentation is significantly associated with worse postoperative BCVA. However, the presence of foveal cystoid change is not significantly associated with postoperative BCVA. CONCLUSIONS: The ELM and EZ line at the fovea recovered and the presence of glial cells and cystoid space resolved gradually after surgery. The postoperative visual acuity was correlated with resolved glial cells and a restored ELM and EZ line. SN - 1879-1891 UR - https://www.unboundmedicine.com/medline/citation/25817009/Correlation_Between_the_Dynamic_Postoperative_Visual_Outcome_and_the_Restoration_of_Foveal_Microstructures_After_Macular_Hole_Surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9394(15)00159-2 DB - PRIME DP - Unbound Medicine ER -