Korean J Ophthalmol.  2008 Jun;22(2):137-142. 10.3341/kjo.2008.22.2.137.

Reorganization of Photoreceptor Layer on Optical Coherence Tomography Concurrent with Visual Improvement after Macular Hole Surgery

• Lee JE
• Lee SU
• Jea SY
• Choi HY
• Oum BS

• KMID: 1099010
• DOI: http://doi.org/10.3341/kjo.2008.22.2.137

Abstract

To report three cases in which reorganization of the photoreceptor layer on optical coherence tomography (OCT) was concurrent with long-term visual recovery after macular hole surgery. Serial OCT scans of three eyes in which visual acuity continued to improve for 1 or more years after successful macular hole surgery were reviewed. Case 1. At postoperative four weeks, visual acuity was 20/100 with disorganized photoreceptor layer on OCT. The photoreceptor layer had been reorganized and visual acuity had improved to 20/25 by 1 year. Case 2. Two weeks after the operation, visual acuity was 20/125 and disorganization of the photoreceptor layer was noted. Visual acuity improved to 20/50 by four months. The photoreceptor layer had been partly reorganized and had appearance of a broken line. Visual acuity had improved to 20/40 and the photoreceptor layer had been reorganized further with a residual defect on OCT by 15 months. Case 3. Visual acuity at two weeks was 20/100. OCT revealed disorganization of the photoreceptor layer. Six months after the operation, the partly reorganized photoreceptor layer appeared as a broken line and visual acuity had reached 20/80. Visual acuity had improved further to 20/40 by 1 year, concurrent with improved organization of the photoreceptor layer. The reorganization of the photoreceptor layer plays a part in long-term improvement of visual acuity after macular hole surgery.

Keyword

Macular hole; Optical coherence tomography; Photoreceptor reorganization

MeSH Terms

Adult
Aged
Basement Membrane/surgery
Female
Humans
Middle Aged
Photoreceptor Cells, Vertebrate/*physiology
Regeneration/*physiology
Retinal Perforations/*surgery
Tomography, Optical Coherence
Visual Acuity/*physiology
Vitrectomy

Figure

• 

  Fig. 1 Case 1. Serial horizontal optical coherence tomography (OCT) scans after successful macular hole surgery. (A) Preoperative OCT image shows a full-thickness macular hole with a pseudo-operculum. (B and C) Pseudocolor-coded and enhanced images at 4 weeks show disorganization 1820 µm wide (arrow heads) in the photoreceptor layer. Visual acuity was 20/100. (D and E) OCT images at 6 month reveal reorganization of the photoreceptor layer (arrows). The area of disorganization had decreased and visual acuity had improved to 20/40. (F and G) By 1 year, visual acuity had improved to 20/25, concurrent with further reorganization of the photoreceptor layer (arrows). The changes of the photoreceptor layers can be identified more clearly on the enhanced images (C, E and G) than with the conventional images (B, D and F). (H, I, and J) Video images taken simultaneous with the OCT scans show the identical location of the scans.

• 

  Fig. 2 Case 2. Serial horizontal optical coherence tomography (OCT) scans after successful closure of macular hole after surgery. (A) OCT scan at the presentation demonstrates a full-thickness macular hole with cystic changes of the sensory retina around the hole. (B and C) Conventional and enhanced images at 2 weeks show broad disorganization of the outer retina (arrow heads). Visual acuity was 20/125. (D and E) At 4 months, the photoreceptor layer was partly reorganized on the enhanced OCT images. Visual acuity improved to 20/50. (F and G) At 15 months, the OCT images reveals the reorganized photoreceptor layer (large arrows) with a small defect (small arrows), which is identified more clearly on the enhanced image. Visual acuity was 20/40. (H, I, and J) Video images taken simultaneous with the OCT scans show the identical location of the scans.

• 

  Fig. 3 Case 3. Serial horizontal optical coherence tomography (OCT) scans after successful macular hole surgery. (A) Preoperative OCT scan shows a stage 2 macular hole. (B and C) Conventional pseudocolor image and enhanced image at 2 weeks demonstrate disorganization of the outer retina (arrow heads). The width was measured as 1260 µm. (D and E) At 6 months, OCT images disclose the partly reorganized photoreceptor layer, which appeared as a broken line on the enhanced image (arrows). (F and G) At 1 year, further reorganization of the photoreceptor layer is identified (arrows). Visual acuity improved gradually from 20/100 (2 weeks) to 20/80 (6 months) and then to 20/40 (1 year). (H, I, and J) The identical location of the OCT scans was verified based on the video images taken simultaneous.

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