Long-term functional outcome of macular hole surgery correlated to optical coherence tomography measurements

Objective: Evaluation of long-term functional outcome after macular hole surgery and its correlation with postoperative optical coherence tomography (OCT). Methods: Before and after surgery a complete clinical examination and OCT were performed in 38 patients. Best corrected postoperative visual acuity (VA) was correlated to the following OCT parameters: preoperative base and minimum diameter of the hole, hole height, hole form factor, retinal thickness and nerve-fibre layer measurements postoperatively, postoperative foveal contour, appearance of retinal pigment epithelium layer and photoreceptor layer. Results: Over a mean follow up of 67 months, VA improved significantly (P = 0.01). Retinal thickness and retinal thickness and nerve-fibre layer measurements of the operated eye did not differ from fellow eye. A negative correlation was seen between final VA and preoperative base diameter of the hole (r = -0.41, P = 0.02) and hole height (r = -0.45, P = 0.01). The correlation between hole form factor values and final VA (r = 0.36, P = 0.04) was weak. Appearance of the photoreceptor band was the only OCT parameter significantly correlating with final VA (r = -0.42, P = 0.01) and explaining the observed increase (r = -0.32, P = 0.05) in VA. Conclusion: Appearance of the photoreceptor layer on postoperative OCT correlates to functional outcome and may help to explain cases of unsatisfactory postoperative VA despite successful hole closure.