Visual acuity and photoreceptor inner segment/outer segment structure changes of idiopathic macular hole patients after micro-invasive vitrectomy

Objective To observe outcome of visual acuity and photoreceptor inner segment (IS)/outer segment (OS) changes in idiopathic macular hole (IMH) patients after micro-invasive vitrectomy.Methods Forty patients (40 eyes) with idiopathic macular hole underwent micro-invasive vitrectomy were enrolled in this study.The patients included 12 males and 28 females,with an average age of (62.43 ± 5.68) years,with an average course of 2.78 months.All the patients were examined for best corrected visual acuity (BCVA),intraocular pressure,slit lamp ophthalmoscopy combine with preset lens,fundus color photography and optical coherence tomography (OCT) examination.The BCVA was converted to logarithm of the minimal angle of resolution (logMAR).The BCVA was 0.05-0.5,with an average log MAR BCVA of 0.71±0.19.The average diameter of minimum macular hole was (410.13± 175.72) μm.The average base diameter of maximum macular hole was (775.00± 264.77) μm.The diameter of IS/OS defect was 618-2589 μm,with an average of (1682.08±484.11) μm.There were 4,16,20 eyes with stage Ⅱ,Ⅲ,Ⅳ macular hole,respectively.The follow up period was 33.75 months.BCVA and macular structure at month 1,3 and the final follow-up after surgery were analyzed.The correlation among logMAR BCVA,diameter of IS/OS defect at final follow-up and the follow-up time was analyzed.Results The mean logMAR BCVA at month 1,3 and the final follow-up after surgery were 0.49±0.31,0.37±0.26,0.30±0.26 respectively.Compared with the mean preoperative logMAR BCVA,the differences were significant (Z=-4.598,-5.215,-5.218; P＜0.05).The preoperative logMAR BCVA and the diameter of minimum macular hole were significantly correlated with the postoperative logMAR BCVA at final follow-up (r=0.401,0.392,P＜0.05).The preoperative diameter of IS/OS defect and the postoperative diameter of IS/OS defect at final follow-up were significantly correlated with the postoperative logMAR BCVA at final follow up (r=0.339,0.353; P＜0.05).The time of final follow up was not correlated with the postoperative logMAR BCVA and the diameter of IS/OS defect at final follow-up (r=0.000,0.018; P＞ 0.05).At the final follow-up,the macular holes were totally closed in 39 eyes (97.5％).Thirty-two eyes exhibited a complete recovery of IS/OS junction,8 eyes continued to exhibit an IS/OS junction defect.Conclusion Micro-invasive vitrectomy can stabilize vision of IMH patients,and promote complete recovery of IS/OS. Key words: Retinal perforations/surgery;  Photoreceptor connecting cilium/pathology;  Vitrectomy