Correlation Between Outer Retinal Structure And Visual Function Recovery In Patients With Idiopathic Macular Hole

Objective :To investigate the correlation between outer retinal structure and postoperative visual function recovery in idiopathic macular hole(IMH)with different diameters.Methods:This was a retrospective case series study.Forty eyes of 40 patients with IMH who underwent vitrectomy combined with internal limiting membrane peeling surgery from June 2018 to December 2021 in the Affiliated Hospital of Chengde Medical College were divided into two groups.There were 20 eyes with the minimum hole diameter of 250 to 400 μm as the middle hole group and 20 eyes with more than 400 μm as the large hole group according to the minimum diameter of macular hole.The intraocular pressure,ocular B ultrasound,best corrected visual acuity(BCVA),optical coherence tomography(OCT),Amsler square table and other examinations were observed before and after surgery.The repair of outer retina and visual function the correlation between preoperative external membrane(ELM)height,ELM height ratio,ELM relative ratio,ELM defect length,ellipsoid zone defect length,interdigitation zone defect length and postoperative visual acuity were analyzed.The follow-up time was 6 months after surgery.Results:1.During the final follow-up,in the middle hole group,metamorphopsia disappeared in 16 eyes and improved in 4 eyes compared with that before operation;in the large hole group,metamorphopsia disappeared in 9 eyes,improved in 6 eyes compared with that before operation,and 5 eyes had no improvement.BCVA at 1,3 and 6 months after operation was significantly higher than that before operation in both groups(all P<0.001),while there was no significant difference in BCVA between 3 and 6 months after operation(Pmiddle hole group=0.117,Plarge hole group=0.082).2.The length of ELM,ellipsoid zone and interdigitation zone defects at 1,3 and 6 months after operation in both groups were reduced compared with those before operation(all P<0.001).Pearson correlation analysis showed that the visual acuity(BCVA,logMAR)in the middle hole group was positively correlated with preoperative ELM height,ELM height ratio,ELM defect length,ellipsoid zone defect length,and interdigitation zone defect length(r=0.70,0.48,0.45,0.65,0.61;P=0.001,0.031,0.047,0.002,0.004)and negatively correlated with ELM relative ratio(r=-0.46,P=0.041)at 6 months after surgery;the visual acuity(BCVA,logMAR)in the large hole group was positively correlated with preoperative ELM height ratio,ELM defect length,ellipsoid zone defect length,and interdigitation zone defect length(r=0.47,0.51,0.66,0.57;P=0.036,0.023,0.002,0.009),negatively correlated with ELM relative ratio(r=-0.49,P=0.029),but not correlated with preoperative ELM height(r=0.40,P=0.078).Conclusions:1.The visual acuity and metamorphopsia of the patients with idiopathic macular hole are improved in different degrees after operation,and the visual acuity tend to be stable at 3 months after operation.2.The outer retinal structure of the defect is gradually repaired from inside to outside after idiopathic macular hole surgery.The preoperative ELM height,ELM height ratio,ELM relative ratio,ELM defect length,ellipsoid zone and interdigitation zone defect length are correlated with the postoperative visual acuity recovery,and when the minimum diameter of macular hole is larger than 400 μm,the preoperative ELM height is not correlated with the postoperative BCVA.