Long-term decrease of retinal pigment epithelium defects in large stage iv macular holes with borders mechanically joined during surgery

Abstract

Purpose: The aim of this paper is to present retinal pigment epithelium (RPE) defects in spectral domain optical coherence tomography (SD-OCT) and their gradual resolution over time.

Materials and methods: Observational case series of 3 eyes of 3 patients who were followed for a period of 3-6 years after undergoing surgery to mechanically close the borders of large stage IV macular holes. Photoreceptor defects and RPE defects were measured during this period with SD-OCT.

Results: In all cases, a reduction in the size of the areas of photoreceptor and RPE defects was noted, which correlated with late improvement in visual acuity (VA).

Conclusions: In eyes with no underlying retinal pigment epithelial or choroidal disease, restoration of RPE is possible in vivo for up to several years after surgery for macular hole closure. An improvement in VA is possible, even lasting many years after successful macular hole surgery, which corresponds to a decrease in both RPE defects and the size of the defects in the junction between the inner and outer segments of photoreceptors.

Keywords: Macular hole; Photoreceptor defects; Retinal pigment epithelium defects; Spectral domain optical coherence tomography.

Fig. 1

Patient 1. RPE defect (arrows) 6 years after macular hole surgery to join the hole borders. a Scanning laser ophthalmoscopy. b Fundus autofluorescence. c SD-OCT 6 years after surgery.

Fig. 2

Patient 2. SD-OCT and SD-OCT fundus maps 1 week (a-e) and 3 years (f-j) after macular hole surgery to join the hole borders. Decrease in size of the RPE defect may be observed. a, f SD-OCT B-scan performed at the same level of the retina. b, g SD-OCT fundus map. c, h SD-OCT retinal thickness map, darker colors mean thinner retinal tissue. d, i SD-OCT nerve fiber layer map, darker colors mean thinner retinal tissue. e, j SD-OCT RPE map, darker colors mean thinner retinal tissue.