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Ellipsoid portion of inner segment line portends visual acuity after macular hole surgery
Spectral-domain optical coherence tomography showed the ellipsoid portion of the inner segment line may be the best predictor of visual recovery after macular hole repair, according to a study.
The retrospective study included 164 eyes of 157 patients who had macular holes and underwent vitrectomy and internal limiting membrane peeling.
LogMAR best corrected visual acuity and SD-OCT images were evaluated preoperatively and postoperatively. Mean follow-up was 29.9 months. Mean patient age was 69 years, with a range from 40 years to 89 years.
Disruption of the ellipsoid portion of the inner segment line was observed on SD-OCT in 60 eyes, and restored ellipsoid portion of the inner segment line was observed in 104 eyes. Patients in the latter group were significantly younger (P = .01).
BCVA improved significantly in both groups (P < .01); improvement in BCVA was significantly greater in eyes with restored ellipsoid portion of the inner segment line (P < .01).
There was a significant association between postoperative BCVA and macular hole minimal diameter and base diameter (both P < .01).
Perspective
Back to TopThis retrospective study reports on macular hole outcomes following pars plana vitrectomy with internal limiting membrane (ILM) peel and gas-fluid exchange with 1 year of follow-up. The authors demonstrate that the presence of an intact ellipsoid portion of the inner segment (EIS) stripe with an intact external limiting membrane (ELM) stripe correlates with improved visual outcomes as compared to the presence of an intact ELM stripe alone.
In fact, all patients with an intact EIS band had an intact ELM, suggesting that the glial cell function may be necessary to restore the EIS band, perhaps in a stepwise fashion. Importantly, their data corroborates the well-established knowledge that preoperative visual acuity and size of macular hole predicts postoperative visual results.
It would be interesting to know if staging of the macular hole may have predicted the optical coherence tomography (OCT) findings or what differences may occur if the ILM is not peeled. Some controversy exists as to the exact anatomic correlates of various hyper-reflective bands seen on OCT.
Overall, this article contributes to our understanding of normal postoperative healing from successful macular hole closure and lends to further discussion regarding relative importance and anatomic correspondence of various OCT bands.