Kerala Journal of Ophthalmology (Jan 2016)
Correlation between the health of the cone outer segment tips line and ellipsoid zone with vision after macular hole surgery
Abstract
Purpose: To determine whether preoperative cone outer segment tips (COST) line, ellipsoid zone (EZ), and external limiting membrane (ELM) defects is significantly related with postoperative recovery of photoreceptors and vision after type 1 macular hole closure. Materials and Methods: A retrospective observational study was conducted on 28 eyes of 28 patients with surgically closed macular holes. Heidelberg's Spectralis optical coherence tomography (OCT) was used to obtain images of the foveal area, and lengths of COST line defect, EZ defect, and ELM defect were measured preoperatively and at 1 month, 3 months, and 6 months after surgery. The pattern of recovery of the photoreceptor layers was observed as complete recovery, incomplete recovery, or disrupted. Results: It was observed that 13 out of 28 eyes with a mean preoperative length of foveal COST line defect 303.8 microns, showed a significant visual improvement in the range of 0.17 logMAR units (6/9-6/6) with complete or incomplete recovery of the EZ and ELM. Twelve patients with mean preoperative length of foveal COST line defect 632 microns showed only slight visual improvement by one or two lines in the range of 0.47 logMAR units (6/18), with an incomplete pattern of photoreceptor recovery. However, 3 patients with a mean preoperative COST line defect of 815 microns did not show any visual improvement of 0.61 logMAR units (6/36) with EZ and ELM disruptions postoperatively. Conclusion: The length of preoperative COST line defect is predictive of the recovery and arrangement of photoreceptors and best corrected visual acuity after type 1 macular hole closure. Eyes with complete and incomplete recovery of COST, EZ, and ELM were associated with significantly better visual acuity as compared to eyes with a disrupted pattern of photoreceptor recovery.
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