Macular Hole Closure Patterns Affects Postoperative Visual Acuity

Idiopathic macular holes can be close in either a round or linear pattern, depending on the baseline hole orientation, and eyes with larger holes that close in a linear pattern tend to have better final visual acuity than those with round closure, according to research published in Ophthalmology Retina.

Researchers conducted a retrospective, multicentric, observational study to determine the post-operative enface optical coherence tomography (OCT) pattern of closure in eyes with idiopathic macular holes. The main outcome measures were the type of hole closure on enface OCT and comparison of baseline parameters and final visual acuity among the enface closure types.

A total of 64 eyes of 62 patients (mean age, 63.8±12.4 years; 65% women and 35% men). The mean baseline visual acuity was 0.97±0.46 logMAR. The baseline horizontal and vertical minimum linear diameter (MLD) was 591.7±219.4 μm and 552.9±198.2 μm, respectively. The baseline horizontal and vertical basal hole diameter was 1240.3±521.1 μm and 1142.1±478.1 μm, respectively. The mean hole height was 394.8±123.2 μm. 

The investigators noted 2 distinct patterns on enface OCT, round (n=38) and linear (n=26; horizontal, n=17; oblique, n=7; and vertical, n= 2 eyes). They reported a mean final visual acuity of 0.80±0.43 logMAR and, when holes had an MLD of larger than 650 μm, a linear closure had a significantly better mean visual acuity than a round closure (0.76±0.23 logMAR vs 1.07±0.28 logMAR; P=.03).

“In conclusion, macular holes can either undergo a round/ centripetal closure or a linear closure depending on the baseline hole orientation,” stated the researchers. “[E]yes with linear closure had better final visual acuity at 3 months than those with round closure, only in holes with [minimum linear diameter] higher than 650 microns, but no statistically significant difference was seen when other [minimum linear diameter] cut-offs were used.”

The primary limitations of the study included the retrospective design and small sample size.